Background: Pentalogy of Cantrell (PC) is a rare anomaly, and the incidence varies from 5.5 to 7.9 per million live births. The components are defined as a defect of the lower sternum, a midline supraumbilical thoracoabdominal wall defect, a deficiency of the diaphragmatic pericardium, a deficiency of the anterior diaphragm, and congenital cardiac anomalies. The pathognomonic characteristic of this syndrome is the coexistence of omphalocele and ectopia cordis. Diagnosis is possible by antenatal or physical examination, and other tests should be performed to detect other anomalies, including the heart's anomaly. Surgical treatment is complex, and various operative techniques often require a staged approach. The mortality rate is quite high, with a survival rate of less than 5%.

Case presentation: Two-day-old male infant was complained that his heart had been outside his chest wall since birth without covering by skin or sternum. He was born on aterm through section cesarean with a vigorous baby condition. Section cesarean was chosen because his mother has Human Immunodeficiency Virus (HIV)—no family history with similar symptoms. While pregnant, the mother regularly checks with the midwife and fetal ultrasonography only once during the third trimester but did not find the defect, no history of drug abuse, teratogen exposure, smoking, alcohol, or consanguinity. The midline defect extended from the lower part of the sternum completely. Echocardiography found defects such as classic Tetralogy of Fallot, mild atrial regurgitation, mild mitral regurgitation, mild tricuspid regurgitation, and suspect mass at left atrium (LA). The patients underwent surgery by covering the heart with a silo bag. Three days after the procedure, the patient's condition worsened and death because of the sepsis.

Conclusion: Prenatal diagnosis is important in guiding the surgical team to estimate the prognosis and reduce a postnatal management strategy. Early management can provide the basic care necessary to keep the patients until definitive management can be provided.

Background: Bladder stone is a rare disease accounting for 5% of all urinary calculi. It is more common in middle- and low-income countries due to nutritional obstacles, water sanitation, and warm climates. Primary bladder calculi are most common in children younger than 10 years old, with a peak incidence at 2 to 4 years. There have been no reports of bladder stones in children under 2 years of age. This case study aims to evaluate the bladder stone in a 1-year infant with recurrent urinary tract infections.

Case Presentation: An infant boy 1 year and 2 months presented with a 6-month history of complaints of pain on micturition presented with pulling the penis, cloudy urine, and recurrent fever in our clinic. During the 6 months before admission, he visited several pediatric clinics and was diagnosed with and treated for UTI. On ultrasonography, we found a bladder stone 1,9 x 1,3 cm in size. Then we performed open cystolithotomy under general anesthesia. One day after surgery, the patient was discharged from the hospital.

Conclusion: Children who live in endemic areas are more likely to develop bladder stones due to dietary issues. Preventing dehydration, treating urinary tract infections effectively, and securing metabolic abnormalities are the methods for reducing the prevalence of pediatric bladder stones. Pediatric bladder stones must be diagnosed and treated to avoid the stones' recurrence and improve quality of life.

Background: A disorder that manifests on the skin and can be a marker of acquired immunodeficiency syndrome (AIDS) is Kaposi sarcoma (KS). Kaposi sarcoma is a vascular and lymphatic neoplasm caused by human herpesvirus-8 (HHV-8). AIDS-related Kaposi sarcoma is common in homosexuals, bisexuals, and intravenous drug users. This case report will discuss a case of KS in a patient with stage IV human immunodeficiency virus (HIV) infection.

Case description:  A male, 25 years old, with a chief complaint of lumps on the face and body since 7 months ago. Initially, the lumps were few and small, but they have increased in number and size in the last 2 months. Some lumps are purplish red, but there are also skin-colored lumps. There is a history of fever with diarrhea since the previous 6 months and a drastic weight loss in the last 7 months. Dermatological status in the fascial region, anterior and posterior thorax, efflorescences were found multiple nodules, purplish red to skin color, varying in size. Histopathologic examination showed a picture consistent with KS. There was no specific therapy for this patient from the Department of Dermatology and Venereology. Gradually, the patient continued treatment for HIV infection and tracing of other opportunistic infections.

Conclusion: Kaposi sarcoma is a vascular and lymphatic neoplasm sign of AIDS. Treatment in KS focuses more on antiretrovirals for HIV infection.

Latar belakang: Salah satu kelainan yang bermanifestasi pada kulit dan dapat menjadi penanda acquired immunodeficiency syndrome (AIDS) adalah sarkoma Kaposi (SK). Sarkoma Kaposi merupakan neoplasma vaskular dan limfatik yang disebabkan human herpesvirus-8 (HHV-8). Sarkoma Kaposi terkait AIDS paling sering ditemukan pada kelompok homoseksual, biseksual, dan pengguna obat-obatan intravena. Laporan kasus ini akan membahas kasus SK pada pasien dengan infeksi human immunodeficiency virus (HIV) stadium IV.

Deskripsi kasus: Seorang laki-laki, 25 tahun, dengan keluhan utama benjolan di wajah dan badan sejak 7 bulan yang lalu. Awalnya benjolan berjumlah sedikit dan berukuran kecil, namun makin lama makin banyak dan bertambah besar dalam 2 bulan terakhir. Beberapa benjolan berwarna merah keunguan, namun terdapat juga yang sewarna kulit. Terdapat riwayat demam hilang timbul disertai diare sejak 6 bulan terakhir dan penurunan berat badan drastis dalam 7 bulan terakhir. Status dermatologis pada regio fasialis, toraks anterior et posterior didapatkan efloresensi nodul multipel, berwarna merah keunguan hingga sewarna kulit, ukuran bervariasi. Pada pemeriksaan histopatologi didapatkan gambaran sesuai dengan sarkoma Kaposi. Tidak ada terapi spesifik untuk pasien ini dari Departemen Dermatologi dam Venereologi. Secara bertahap, pasien melanjutkan terapi untuk infeksi HIV dan penelusuran infeksi oportunistik lain.

Simpulan: Sarkoma kaposi merupakan neoplasma vaskular dan limfatik yang menjadi penanda kondisi AIDS. Terapi pada SK lebih menitikberatkan pada terapi penyakit dasar yaitu pemberian antiretroviral untuk infeksi HIV.

Background Mother-to-child transmission (MTCT) of human immune virus (HIV), syphilis, and hepatitis B can lead to significant health burdens and even mortality in children. This study aimed to evaluate the effectiveness of triple elimination of MTCT in a secondary hospital in Buleleng, North Bali

Method: This study conducted a retrospective review of 345 pregnancy case in Buleleng General Hospital from January to December 2022

Result: In this study, 98.5% of the 345 pregnant women seeking antenatal care were tested for HIV, syphilis, and hepatitis B. Among the tested patients, 100%, 99.7%, and 98.8% were tested for HIV and hepatitis B, HIV and syphilis, and syphilis and hepatitis B, respectively. The prevalence of HIV, syphilis, and hepatitis B was 1.4%, 2.1%, and 4.3 %, respectively. Antiretroviral therapy was administered to 80 % of HIV-positive patients, and 71.4 % of syphilis patients received benzathine penicillin G. Only 6.6% of hepatitis B patients received hepatitis B virus deoxyribonucleic acid (HBV DNA) & hepatitis B  envelope antigen (HBeAg) examination followed by Lamivudine administration.

Conclusion: Early detection of HIV, syphilis, and hepatitis B in pregnant women is important for preventing MTCT. Coverage of triple elimination screening is in accordance with WHO targets, but further management of hepatitis B needs to be improved

Introduction: Psoriasis vulgaris can affect patients' quality of life due to its clinical appearance, expensive treatment costs, and side effects of therapy. Effective long-term treatment with secukinumab injection can help improve this condition. This study aims to identify psoriasis vulgaris conditions with secukinumab injection based on disease severity and quality of life.

Methods: This study is a cross-sectional descriptive study. Data were taken from patients' medical records at the Dermatology and Venerology Polyclinic of Prof. dr. I G. N. G. Ngoerah Hospital, Denpasar, Bali, from January 2019-December 2021. Demographic characteristics variables were age, gender and history of comorbidities. Variables that reflect disease severity and quality of life were body surface area (BSA), Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI). The distribution of BSA, PASI and DLQI scores is shown in a box plot. In comparison, the distribution of the number of cases based on each category of BSA, PASI and DLQI is presented in a proportion table.

Results: There were 17 patients, mostly men, with a mean age of 38. Patients' Diagnoses were divided into psoriasis vulgaris (52.9%) and psoriasis vulgaris with psoriatic arthritis (47.1%). Based on BSA, clinical improvement was seen two weeks after initiation of therapy, while the BSA grade category improved when entering the maintenance phase. Based on the PASI score, were decreased after an average of 1 week since initiation, and the PASI grade category improved after an average of 2 weeks. Finally, based on the DLQI score, the patient's quality of life improved after an average of 4 weeks since initiation.

Conclusions: There was an improvement in the severity of psoriasis vulgaris according to BSA, PASI score and overall DLQI after two cycles of initial dosing of secukinumab injection.

Background: Pseudomonas aeruginosa is an opportunistic pathogen that has the potential to cause severe degrees of healthcare-associated infections, especially in immunocompromised patients who have AIDS, cancer, burns, and respiratory tract infections. Antibiotic resistance genes by genetic elements are increased so that it becomes a worldwide concern and also causes the evolution of resistant strains (MDR) ERIC-PCR technique is a PCR-based method in which the location and number of different ERIC sequences in bacteria are used as genetic markers of bacterial diversity.

Case Presentation: We presented three patients with Pseudomonas aeruginosa infection treated in the ICU (Intensive Care Unit) room of Prof. dr. I. G. N. G Ngoerah Hospital. While being treated in the ICU, the three patients' beds were located side by side in one room. Three patients, in this case, reports were treated in the same room where the beds were side by side and experienced a worsening of their condition. After examination, it was found that the bacteria that caused the infection was Pseudomonas aeruginosa. However, after conducting molecular analysis using the ERIC-PCR method, there was no gene similarity between the three isolates examined. This might have happened because the patient had been treated in a different room before being admitted to the ICU.

Conclusion: We presented a discrepancy between Pseudomonas aeruginosa infection in three patients treated in the same ICU room. However, the ERIC-PCR results found no gene similarity between the three isolates examined.

Background: Indonesia ranks 4th in terms of the number of people with diabetes mellitus in the world, and chronic complications in DM include disorders of the nerves (neuropathy). Paraparesis causes disturbances in mobility and disturbances to the person, namely the perception of his disability which can lead to reactions of disappointment, low self-esteem and ends in despair and depression. This case report aims to describe insulin-induced depression and chronic pain in diabetic neuropathy patient with lower motor neuron paraparesis.

Case Presentation: A 36-year-old Balinese woman could not walk, she had been complaining of sadness for a long time, since she was told she had diabetes, thus limiting her daily activities. The patient has a history of diabetic disease since childhood and was definitely diagnosed at the age of 15 around 18 years ago, and started a history of back pain since December 2021 and worsened with cramps and weakness in both legs since January 2022. Vital signs were good, on waist is attached plate metal as high as vertebrae L3–L4, extremities: edema +/- warm +/+, cruris dextra: edema (+), clinical neurology: lower motor neuron type paraparesis, motor weakness, atrophy of musculus gastrocnemius dextra et sinistra and musculus tibialis dextra et sinistra paresthesia of the glove and stocking type. Psychiatric status: reasonable appearance of consciousness: clear, affective. Mood affect: sad/depressive/ appropriate. Thought process: logical realist/coherent/preoccupation with back pain and weak legs. Mixed-type insomnia exists; history of raptus and hypobulia is present. Impulse control: poor.

Conclusion: Patients with diabetes on insulin treatment were associated with the prevalence of depressive syndromes.

Latar belakang: Indonesia menempati urutan ke-4 terbesar dalam jumlah penderita diabetes melitus di dunia, dan komplikasi kronis pada diabetes antara lain kelainan pada saraf (neuropati). Paraparese menyebabkan gangguan dalam mobilitas serta gangguan terhadap pribadinya yaitu persepsi kecacatannya yang dapat menimbulkan reaksi kecewa, rendah diri dan berakhir pada keadaan putus asa dan depresi. Laporan kasus ini bertujuan mendeskripsikan depresi yang diinduksi insulin dan nyeri kronis pada pasien neuropati diabetik dengan paraparesis tipe lower motor neuron.

Presentasi Kasus:  Perempuan 36 tahun suku Bali, tidak bisa berjalan, keluhan sedih sudah lama, semenjak dikatakan mempunyai penyakit diabetes, sehingga membatasi aktivitasnya sehari hari. Pasien memiliki riwayat penyakit diabetes dari kecil dan terdiagnosis pasti pada umur 15 tahun sekitar 18 tahun yang lalu, dan mulai riwayat nyeri punggung sejak bulan desember 2021 dan memberat dengan kram dan lemah pada kedua kaki sejak Januari 2022.  Tanda vital baik, pada pinggang terpasang: plat logam setinggi vertebra L3–L4, ekstremitas: edema +/- hangat +/+, kruris dekstra: edema (+). Klinis neurologis: paraparesis tipe lower motor neuron, kelemahan motorik, atrofi musculus gastrocnemius dekstra et sinistra dan musculus tibialis dekstra et sinistra, parestesia tipe gloves and stocking. Status psikiatri: penampilan wajar kesadaran: jernih. Mood afek: sedih/depresif/appropriate. Proses pikir: logis realis/koheren/preokupasi nyeri punggung dan lemah kaki. Insomnia tipe campuran ada; raptus ada riwayat dan hipobulia ada. Pengendalian impuls: kurang baik.

Simpulan: Diabetes pada pengobatan insulin dikaitkan dengan prevalensi sindrom depresi, menunjukkan hubungan yang permanen dan signifikan.

Introduction: Fahr's syndrome is a rare disorder characterized by bilateral abnormal calcium deposits in the cerebral cortex and basal ganglia. This condition is often asymptomatic but can also cause symptoms of neurological dysfunction, movement disorders, and psychiatric symptoms. Radiological imaging, such as a CT scan, can be used to confirm the diagnosis. This case report discusses the clinical manifestations and radiological features of Fahr's syndrome in a 45-year-old female patient with a history of thyroidectomy.

Case Report: A 45-year-old woman was referred with complaints of weakness, fever, and pain in the chest, lower abdomen, right thighs, and right upper back after being exposed to hot water. The patient was found suddenly unconscious while carrying a pot of hot water. The patient has a history of enlargement of the thyroid gland, has undergone thyroid removal surgery 10 years ago, and has had epilepsy since 2 years ago. Physical examination showed low blood pressure, fever, and burns in the right chest area, right lower abdomen, right thigh, and right upper back. Neurologic examination within normal limits. A laboratory examination found leukocytosis, hyponatremia, and hypokalemia. A CT scan of the head without contrast showed multiple symmetrical calcifications in the cerebellum, caudate nucleus, thalamus, lentiform nucleus, and white and gray matter of the frontal lobes, parietal lobes, and occipital lobes.

Conclusion: Radiological examinations such as CT scans can be performed in patients with neurological symptoms and a history of total thyroidectomy to establish the diagnosis of Fahr's syndrome.

Pendahuluan: Sindrom Fahr merupakan kelainan langka yang ditandai dengan adanya deposit kalsium abnormal bilateral pada korteks serebral dan ganglia basalis. Kondisi ini seringkali tanpa gejala, namun juga dapat menyebabkan gejala disfungsi neurologis, gangguan gerakan dan gejala psikiatri. Pencitraan radiologi seperti CT scan dapat digunakan untuk menegakkan diagnosis. Laporan kasus ini membahas tentang manifestasi klinis dan gambaran radiologis sindroma Fahr pasien perempuan usia 45 tahun dengan riwayat tiroidektomi.

Laporan Kasus: Wanita berusia 45 tahun dirujuk dengan keluhan lemas, demam, nyeri pada dada, perut bawah, paha, dan punggung atas sebelah kanan setelah terkena air panas. Pasien ditemukan tiba-tiba tidak sadarkan diri ketika sedang membawa panci berisi air panas. Pasien memiliki riwayat epilepsi sejak 2 tahun yang lalu serta memiliki riwayat pembesaran kelenjar tiroid dan sudah menjalani operasi pengangkatan tiroid. Pemeriksaan fisik menunjukkan tekanan darah rendah, demam, dan luka bakar pada daerah dada kanan, perut bawah kanan, paha kanan, dan punggung atas sebelah kanan. Pemeriksaan neurologis dalam batas normal. Pada pemeriksaan laboratorium ditemukan leukositosis, hiponatremia dan hipokalemia.  Pemeriksaan CT scan kepala tanpa kontras menunjukkan kalsifikasi multiple simetris pada daerah cerebellum, nukleus kaudatus, talamus, nukleus lentiformis, dan white serta gray matters lobus frontalis, lobus parietalis, dan lobus occipitalis.

Kesimpulan: Pemeriksaan radiologis seperti CT scan dapat dilakukan pada pasien dengan gejala neurologis dan riwayat total tiroidektomi untuk menegakkan diagnosis sindrom Fahr.

Background: Acute Infection Fungal Rhinosinusitis (AIFRS) is an uncommon inflammation of the paranasal sinus mucosa. Although the incidence of fungal sinusitis is still rare, there has been an increase in cases over the past few decades. Invasive fungal sinusitis occurs more frequently in patients with weakened immune systems. Diagnosis of fungal sinusitis involves a medical history assessment, physical examination, and supportive tests such as CT-scan. CT-scan to aid in confirming the diagnosis of invasive fungal sinusitis and help in planning appropriate management. Surgery, such as the Luc-Caldwell (LCW) procedure. Through this article, the authors aim to describe cases of fungal invasive maxillary sinusitis and diagnostic approaches with CT-Scan and Luc-Caldwell's treatment (LCW).

Case Presentation: A 61-year-old male complained of swelling, pus, and pain in his right eye. He had a history of sinus surgery. Physical examination revealed swelling in the right eye, and anterior rhinoscopy showed sinuses filled with greenish secretions. A CT scan showed extensive sinus inflammation involving the right eye area. The patient was diagnosed with maxillary, ethmoid, and frontal fungal sinusitis. A Luc-Caldwell (LCW) surgery was performed in collaboration with an ophthalmologist. Following the surgery, the swelling and pus in the eye decreased, and the pain in the cheek resolved.

Conclusion: Early diagnosis is crucial in cases of suspected AIFRS to improve patient outcomes and reduce morbidity. Diagnosing this condition can be challenging due to its non-specific clinical presentation. Initial diagnostic investigations that can be performed include computed tomography (CT).

Latar Belakang: Acute Infection Fungal Rhinosinusitis (AIFRS) adalah peradangan jamur pada mukosa sinus paranasal yang jarang ditemukan. Meskipun insiden sinusitis jamur masih jarang, saat ini terjadi peningkatan kasus dalam beberapa dekade terakhir. AIFRS lebih sering terjadi pada pasien dengan sistem kekebalan tubuh yang lemah. Diagnosis AIFRS melibatkan penilaian riwayat penyakit, pemeriksaan fisik, dan penunjang seperti CT-Scan. CT-Scan membantu dalam mengonfirmasi diagnosis AIFRS dan dapat digunakan sebagai panduan tindakan bedah. Melalui artikel ini, penulis bertujuan untuk mendeskripsikan kasus mengenai sinusitis maksilaris jamur invasif dan pendekatan diagnosis dengan CT-Scan dan tatalaksana Luc-Caldwell (LCW).

Persentasi Kasus: Seorang pria berusia 61 tahun mengeluh pembengkakan, keluar nanah, dan nyeri pada mata kanannya. Pada pemeriksaan fisik didapatkan pembengkakan pada mata kanan, dan rhinoskopi anterior menunjukkan sinus yang terisi dengan sekret berwarna hijau. CT-Scan menunjukkan peradangan sinus yang luas yang melibatkan area mata kanan. Kemudian, pasien didiagnosis dengan sinusitis jamur maksila, etmoid, dan frontal. Pasien kemudian dilakukan tindakan Luc-Caldwell (LCW) oleh dokter spesialis THT-KL bekerjasama dengan seorang oftalmologis. Setelah operasi, pembengkakan dan nanah pada mata berkurang, dan nyeri pada pipi hilang.

Kesimpulan: Diagnosis dini sangat penting dalam kasus kecurigaan AIFRS untuk meningkatkan outcome pasien dan mengurangi morbiditas. Untuk mendiagnosis kasus ini bisa menjadi tantangan karena gambaran klinisnya yang tidak spesifik. Pemeriksaan diagnostik awal yang dapat dilakukan meliputi computed tomography (CT).

Background: Cerebral palsy (CP) diplegia is a neurological condition that occurs in infancy or early childhood, and permanently affects muscle control and coordination, with lower limb conditions more severe than upper limb. Symptoms can be an increase in muscle tone that causes spasticity in the feet. The arm muscles are generally less affected or not affected at all. Symptoms in addition to motor disorders can be accompanied by sensory and cognitive disorders. Management of physiotherapy with passive stretching (PS), peripheral joint mobilization (PJM), myofascial release technique (MRT), neurodevelopmental technique (NDT), boccia rehabilitation program (BRP) and aquatic exercise increase boccia sports performance in children with cerebral palsy diplegia.

Case Report: A 16-year-old male patients with complaints of unable to stand upright, both legs experience stiffness, and hunchbacked body posture (kyphosis) and forward head. Complaints in patients cause limitations and disorders of motion and function, such as stiffness in both feet, decreased balance capability, decreased gross motor skills and decreased precision ability in throwing. The physiotherapy program was conducted in four meetings in four weeks and patients get physiotherapy programs in the form of PS, PJM, MRT, NDT, BRP and aquatic exercise. Physiotherapy programs get the results of an increase in functional abilities of balance and increase precision capabilities in the throw.

Conclusion: Provision of PS, PJM, MRT, NDT, BRP and aquatic exercise programs increases the ability of functional balance and increase precision capabilities in throwing.

Latar Belakang: Cerebral palsy (CP) diplegia merupakan suatu kondisi neurologis yang terjadi pada masa bayi atau anak usia dini, dan secara permanen mempengaruhi kontrol dan koordinasi otot, dengan kondisi ekstremitas bawah lebih berat daripada ekstremitas atas. Gejalanya bisa berupa peningkatan tonus otot yang menyebabkan spastisitas di kaki. Otot lengan umumnya kurang terpengaruh atau tidak terpengaruh sama sekali. Gejala selain gangguan motorik bisa disertai gangguan sensori maupun kognitif. Penanganan fisioterapi dengan passive stretching (PS), peripheral joint mobilization (PJM), myofascial release technique (MRT), neurodevelopmental technique (NDT), boccia rehabilitation program (BRP) dan aquatic exercise meningkatkan performa olahraga boccia pada anak dengan diagnosa CP diplegia.

Laporan Kasus: Pasien laki-laki berusia 16 tahun dengan keluhan belum bisa berdiri dengan tegak, kedua kaki mengalami kekakuan, dan postur tubuh bungkuk (kifosis) serta forward head. Keluhan pada pasien menyebabkan timbulnya keterbatasan dan gangguan gerak dan fungsi antara lain seperti kekakuan pada kedua kaki, penurunan kemampuan keseimbangan, penurunan kemampuan motorik kasar serta penurunan kemampuan presisi dalam lemparan. Program fisioterapi dilakukan sebanyak empat kali pertemuan dalam empat minggu dan pasien mendapatkan program fisioterapi berupa PS, PJM, MRT, NDT, BRP dan aquatic exercise. Program fisioterapi mendapatkan hasil adanya peningkatan kemampuan fungsional keseimbangan dan peningkatan kemampuan presisi dalam lemparan.

Kesimpulan: Pemberian program PS, PJM, MRT, NDT, BRP dan aquatic exercise meningkatkan kemampuan keseimbangan fungsional serta meningkatkan kemampuan presisi dalam lemparan.

Background: Elizabethkingia infections were reportedly rare, but if it was found, it had been known to cause neonatal meningitis, bloodstream infections and respiratory infections. Elizabethkingia meningoseptica had a unique antibiotic susceptibility pattern, usually resistant to most antibiotics. Elizabethkingia infections were associated with a high mortality rate because of the lack of effective therapeutic regimens, antibiotic resistance and virulence.

Case Presentation: Fourteen days old boy patient came with the chief complaint of seizure, which occurred twice. Before the seizure, the patient had a fever with the highest temperature was 39°C. The patient looked lethargic, tended to sleep more often, cried occasionally and was not as active as previously. Septic marker revealed an Immature to Total neutrophil (IT) ratio of 0.2 and C-Reactive Protein (CRP) 49.30 mg/dL. A blood smear examination showed toxic granules, vacuolization of the leucocyte and reactive thrombocytosis. Cerebrospinal fluid analysis revealed a cell number of 2520 cell/uL, polymorphonuclear (PMN) cell 80%, mononuclear (MN) cell 20%, Nonne and Pandy was positive, protein level at 300 mg/dL and cerebrospinal fluid glucose level below 20 mg/dL. The patient was initially diagnosed with sepsis and meningitis and was given ampicillin and gentamicin. Blood and cerebrospinal fluid culture isolated Elizabethkingia meningoseptica and significantly as the infection-causing agent. The antibiotic sensitivity of the blood culture was ciprofloxacin and levofloxacin. The antibiotic sensitivity of the cerebrospinal fluid culture was levofloxacin. During the treatment, there were several inappropriate results between clinical manifestation and laboratory results; the antibiotic was changed to levofloxacin according to the sensitivity of the blood and cerebrospinal fluid culture.

Conclusion: Elizabethkingia meningoseptica was a rare case, and the nature of this bacteria was resistant to multiple antibiotics. Treatment should be considered carefully.

Background: Aspergillus spp., Scopulariopsis spp., Alternaria spp., Acremonium spp. and Fusarium spp. is reported to be responsible as the causative agent of infection in 2-25% of all cases of onychomycosis. The resistance of three types of azole (triazole) antifungals has increased in cases of infection due to Aspergillus spp. This case report discusses combining ciclopirox olamine and fluconazole in recalcitrant onychomycosis due to Aspergillus spp. as an alternative therapy.

Case: A 26-year-old woman complained of yellow fingernails 1 year ago. Solitary geographic hyperpigmented macule, brownish yellow onychodyschromia, onycholysis and subungual debris were observed on the fourth digit of the left manus. On examination of 20% potassium hydroxide, long hyphae, and saboraoud dextrose agar (SDA) culture identified Aspergillus spp. Previous treatment was itraconazole 4 pulses and fluconazole 150 mg/week for 3 months showed no improvement. Ciclopirox olamine for 4 months combined with fluconazole 150 mg/week showed healthy nail matrix growth and negative fungal element on a 20% potassium hydroxide examination after 8 weeks of treatment.

Conclusion: Recalcitrant onychomycosis can occur due to resistance to azole antifungals. Administration of topical azoles and ciclopirox combination therapy showed clinical and immunological improvements.

Latar belakang: Aspergillus spp., Scopulariopsis spp., Alternaria spp., Acremonium spp. dan Fusarium spp. merupakan kapang nondermatofita tersering yang dilaporkan bertanggung jawab sebagai agen penyebab infeksi pada 2-25% dari semua kasus onikomikosis. Saat ini resistensi tiga jenis antijamur golongan azol (triazol) meningkat pada kasus infeksi akibat Aspergillus spp. dan terapi inadekuat dapat menyebabkan resistensi dan rekurensi. Laporan kasus ini membahas penggunaan kombinasi siklopiroks olamin dan flukonazol pada onikomikosis rekalsitran karena Aspergilus spp. sebagai terapi alternatif.

Kasus: Seorang perempuan 26 tahun mengeluh kuku jari tangan menguning sejak 1 tahun lalu. Pada digiti IV manus sinistra didapatkan makula hiperpigmentasi soliter bentuk geografika, onikodiskromia kuning kecoklatan, onikolisis dan subungual debris dengan pemeriksaan kalium hidroksida (KOH) 20% ditemukan hifa-hifa panjang dan kultur saboraoud dextrose agar (SDA) teridentifikasi Aspergillus spp. Riwayat terapi sebelumnya dengan itrakonazol 4 denyut dan flukonazol 150mg/minggu selama 3 bulan tidak menunjukkan perbaikan. Siklopiroks olamin selama 4 bulan dengan melanjutkan flukonazol diberikan dan menunjukkan perbaikan matriks kuku normal dan KOH negatif setelah 8 minggu perawatan.

Simpulan: Onikomikosis rekalsitran dapat terjadi karena adanya resistensi terhadap antijamur golongan azol. Pemberian terapi kombinasi golongan azol dan siklopiroks topikal menunjukkan perbaikan klinis serta imunologis.

Background: Kawasaki disease is an acute febrile illness with systemic vasculitis and predominantly causes acquired heart disease. The etiology is still unknown, and there is no specific diagnostic test. The diagnosis was made using clinical criteria, laboratory and echocardiographic findings.  It is characterized by fever, bilateral non-exudative conjunctivitis, erythema of lips and oral mucosa, rash, cervical lymphadenopathy, edema and erythema of the hand and foot. The initial treatment for both complete and incomplete Kawasaki disease is a single high dose of intravenous immunoglobulin (IVIG) and aspirin. The place of corticosteroids in the initial therapy is still controversial.

Case Description: A 3-year-old boy presented with a 7-day history of high fever and not relieved by antipyretic, which was followed by a maculopapular rash on his trunk and extremities, vomiting, reduced appetite, red on her lips and eyes who aspirin, IVIG and corticosteroid treated as initial therapy. He showed clinical improvement and did not have cardiovascular complications.

Conclusion: We report a case of Kawasaki disease in a 3-year-old boy. This case highlighted that adding corticosteroids to IVIG and aspirin as initial therapy might improve outcomes in Kawasaki disease and could be selected as a treatment modality to treat Kawasaki disease.

Background: Bifurcated rib or Bifid rib is considered to be an anatomical overgrowth anomaly of the chest wall, forming a forked sternal end. Diagnosis of this condition is generally an incidental finding on imaging or post-mortem examination. Most of the cases were asymptomatic and established as part of Gorlin syndrome. Here we describe a rare case of chest wall deformity in a paediatric patient, and our approach for this case with limited cost and resources.

Case Presentation: A 5-year-old boy, presented at orthopedic outpatient clinic with complaint of a painless lump in his upper left chest. No significant history of infection, malignancy or any congenital syndromes. Chest imaging revealed a bifid left 4^th rib at the sternal end.

Conclusion: There is currently no data on the best approach to managing bifid ribs. In addition, genetic testing for susceptible genes should be strongly considered. In this situation with limited cost and resources, we suggest close monitoring with regular follow-ups for the patient as the best approach, including detection of any other diagnostic criteria of Gorlin syndrome, to ensure better prognosis and quality of life for this patient.

Background: Obesity in children has its impact when the child experiences infectious conditions common in childhood, such as pneumonia. The increasing incidence of obesity in children in the last three decades forms the basis for compiling this review article. This review article aims to provide current insights about the impact of obesity on respiratory physiology, inflammatory conditions in pneumonia, and drug pharmacodynamics.

Methods: This literature review uses the latest literature relevant to matters affecting pneumonia management and clinical approach in children with obesity. This literature was obtained from various sources of other scientific literature.

Results: Obesity affects the respiratory physiology of children to collapse more easily, energy use becomes less efficient, children become tired, and hypoxemia occurs easily. Obesity also increases the degree and ease of inflammation in pneumonia and affects the pharmacodynamics of several drugs commonly used to manage pneumonia.

Conclusion: Management of pneumonia in children with obesity requires vigilance and more stringent monitoring and adjustment of drug doses.

Peritoneal dialysis can be a treatment for kidney replacement therapy, and the lining of the abdomen can be used as the filter for dialysis. The dialysate is inserted into the abdomen through a peritoneal dialysis catheter. Conventionally, people would wait two weeks after getting a catheter insertion before starting dialysis. This period was to give enough time for the wound to heal correctly. But some studies found that chronic kidney disease patients who need to begin dialysis immediately after having a catheter insert (urgent-start peritoneal dialysis) had similar results to those who started dialysis more than two weeks after inserting the catheter (conventional-start peritoneal dialysis). Peritoneal dialysis is a significant method of kidney replacement therapy. Most patients who need dialysis right away are given hemodialysis instead of peritoneal dialysis, which means that peritoneal dialysis is not used as much as it could be. Urgent-start peritoneal dialysis is an effective and cost-effective option instead of starting conventional dialysis. There is not enough evidence to help guide the treatment, but involvement of the knowledge with this technique is required. This article overviews why urgent-start peritoneal dialysis is important and how it can be used in practice.

The term osteosarcopenia has been coined to describe the concomitant occurrence of osteopenia/osteoporosis and sarcopenia. Osteosarcopenia can occur in patients with SLE due to the inflammatory process and long-term use of glucocorticoids which play a role in the pathophysiology of osteosarcopenia. Until now there is no definite recommendation regarding when to carry out early detection of osteosarcopenia in patients with SLE, but there is a recommendation to carry out screening after 3 months of long-term glucocorticoid use to determine the incidence of glucocorticoid-induced osteoporosis. The gold standard for assessing bone mass is dual X-ray absorptiometry (DXA). For prevention of osteosarcopenia, identification and treatment of modifiable risk factors such as endocrine disorders is essential. In addition, the risk of developing sarcopenia and osteopenia can be reduced through healthy lifestyle changes that optimize stem bone mass and maintain musculoskeletal health throughout life, including regular physical activity and adequate nutrition (intake of calcium, vitamin D and protein).

Istilah osteosarkopenia telah diciptakan untuk menggambarkan kejadian bersamaan dari osteopenia/osteoporosis dan sarkopenia. Osteosarkopenia dapat terjadi pada pasien SLE akibat proses inflamasi dan penggunaan glukokortikoid jangka panjang yang berperan dalam patofisiologi osteosarkopenia. Sampai saat ini belum ada anjuran pasti mengenai kapan harus dilakukan deteksi dini osteosarkopenia pada pasien SLE, namun ada anjuran untuk melakukan skrining setelah 3 bulan penggunaan glukokortikoid jangka panjang untuk mengetahui kejadian osteoporosis akibat glukokortikoid. Standar emas untuk menilai massa tulang adalah dual X-ray absorptiometry (DXA). Untuk pencegahan osteosarkopenia, identifikasi dan pengobatan faktor risiko yang dapat dimodifikasi seperti gangguan endokrin sangat penting. Selain itu, risiko terjadinya sarkopenia dan osteopenia dapat dikurangi melalui perubahan gaya hidup sehat yang mengoptimalkan massa tulang induk dan menjaga kesehatan muskuloskeletal sepanjang hidup, termasuk aktivitas fisik secara teratur dan nutrisi yang cukup (asupan kalsium, vitamin D, dan protein).

Introduction: This study aimed to describe the history, clinical presentation, laboratory examination, treatment, and long-term functional characteristics of patients with septic arthritis of the temporomandibular joint (SATMJ).

Methods: All articles in the English literature on SATMJ were queried using PubMed, Science Direct, and Google Scholar (2013 to 8 March 2023), and the keywords "temporomandibular OR TMJ AND septic arthritis". Articles are included if related to the SATMJ in patients of all ages, using case reports, case series, and cohort studies. The Newcastle-Ottawa Scale was applied to all included investigations. Article selection followed PRISMA’s guidelines for measuring the quality of systematic reviews.

Results: A preliminary literature search yielded 220 results, of which 25 matched the inclusion requirements, and one more came via reference checking. There were 25 cases with a mean age of 26.7 years (0.1 to 85). Symptoms mainly consisted of TMJ/preauricular pain (n=17, 42.5%), trismus (n=20, 50%), and facial/preauricular swelling (n=24, 60%). Most patients had no systemic symptoms (n=16, 40%). The average mouth opening measured 16.3 mm (5 to 36). The diagnosis was made using the following imaging techniques: X-ray (n=6, 15%), CT scan (n=33, 82.5%), MRI (n=16, 40%), and ultrasound (n=1, 2.5%). Staphylococcus aureus (n = 10, 25%) was the most frequently isolated. Approximately 40 patients (100%) received antibiotics, 26 (65%) patients underwent surgery (e.g., joint aspiration, arthroscopy, etc.), of which two patients (5%) required further surgical intervention. In general, long-term results were positive. In 10 of the 40 patients (25%) who had documented follow-up, sequelae occurred.

Conclusion: In the event of trismus, jaw pain, or preauricular edema, SATMJ should be considered. Quick examination and broad-spectrum antibiotic treatment are part of management. Although surgery is not always necessary, it can be life-saving in serious circumstances.

Background: Transfusion-associated circulatory overload (TACO) is a serious complication after blood transfusion. Although the incidence of TACO ranges from 0.1% to 10% of all blood transfusions, the mortality rate is quite high, up to 11 cases per 100,000 transfusions. This literature review aims to identify strategies for managing and preventing TACO in daily clinical practice.

Methods: This literature review was conducted by searching studies on online databases in the form of PubMed, Cochrane Library, and Google Scholar using the keywords “Transfusion-Associated Circulatory Overload” (TACO)”, “blood transfusion”, “pathophysiology”, “management”, “prevention”. Appropriate studies then carried out a narrative synthesis analysis.

Results: In TACO, excess fluid causes pulmonary edema, which can lead to respiratory distress. The main mechanism of TACO is hydrostatic pulmonary edema, in which the accumulation of fluid in the pulmonary capillaries then causes an increase in hydrostatic pressure. The management of TACO includes immediately stopping the administration of transfusion products and supportive therapy in the form of supplemental oxygen administration and administration of diuretics such as furosemide. In contrast, prevention of TACO can be done with a restrictive transfusion strategy, rules for using single-dose red blood cell transfusions, identification of high-risk patients using algorithms or checklists, intensive monitoring of at-risk patients, administration of blood product infusions at a slow rate, and use of diuretic drugs preemptive in at-risk patients.

Conclusion: The main key to the management of TACO is to prevent the further formation of pulmonary edema by stopping the administration of transfusions and giving oxygen and diuretics. Meanwhile, preventive measures can be taken by restricting blood product administration, identifying high-risk patients and pre-emptive diuretic administration.

Latar belakang: Transfusion-associated circulatory overload (TACO) merupakan salah satu komplikasi serius pasca transfusi darah. Meskipun insiden TACO berkisar antara 0,1% hingga 10% dari semua transfusi darah., angka mortalitasnya tergolong cukup tinggi yakni hingga 11 kasus per 100.000 transfusi. Tinjauan pustaka ini bertujuan untuk mengetahui strategi penatalaksanaan dan pencegahan TACO dalam praktik klinis sehari-hari.

Metode: Tinjauan pustaka ini dilakukan dengan pencarian studi pada basis data online berupa PubMed, Cochrane library, dan Google Scholar dengan menggunakan kata kunci “Transfusion-Associated Circulatory Overload” “(TACO)”, “blood transfusion”, “pathophysiology”, “management”, “prevention”.  Studi yang sesuai kemudian dilakukan analisis sintesis secara naratif.

Hasil: Pada TACO terjadi kelebihan cairan yang menimbulkan edema paru yang dapat berujung pada distres nafas. Mekanisme utama terjadinya TACO adalah edema pulmoner hidrostatik, dimana akumulasi cairan pada kapiler pulmoner kemudian menyebabkan peningkatan tekanan hidrostatik. Penatalaksanaan TACO meliputi pengehentian pemberian produk transfusi dengan segera dan terapi suportif berupa pemberian oksigen supplemental serta pemberian diuretik seperti furosemide. Sedangkan pencegahan TACO dapat dilakukan dengan strategi transfusi yang restriktif, aturan penggunaan transfusi sel darah merah dosis tunggal, identifikasi pasien berisiko tinggi dengan menggunakan algoritma atau ceklist, monitoring intensif pada pasien berisiko, pemberian infus produk darah dengan kecepatan lambat, dan penggunaan obat-obatan diuretik preemtif pada pasien berisiko.

Simpulan: Kunci utama penatalaksanaan TACO adalah mencegah terbentuknya edema paru lebih lanjut dengan menghentikan pemberian transfusi dan pemberian oksigen serta diuretik. Sedangkan tindakan pencegahan dapat dilakukan dengan restriksi pemberian produk darah, identifikasi pasien berisiko tinggi hingga pemberian diuretik preemtif.

Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious disease and has become a worldwide pandemic due to Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection. In post-COVID-19 patients, about 10% of patients remain symptomatic for more than three weeks, and less than 10% of patients experience sequelae for months. Patients who have sequelae, known as long COVID syndrome, can experience various impairments in structure and function. Not only in the respiratory tract, but sequelae can also occur in some organs such as the cardiovascular system, musculoskeletal, and even psychological nervous system.

Literature review: Medical rehabilitation has a role in improving functional abilities and improving the quality of life of patients after COVID-19 infection. To find out the impairment that occurs in patients after COVID-19 infection, screening and assessment are needed to determine the severity experienced in COVID-19 survivors. Rehabilitation services are provided in accordance with the severity of patients after COVID-19 infection. There are three levels of recommended rehabilitation service models, such as specialist multidisciplinary team (MDT) services, community-based therapy teams, and self-management.

Conclusion: The rehabilitation program for post-COVID-19 patients is given specifically and differently for each individual, depending on the severity and functional impairment experienced. For this reason, screening and assessment of COVID-19 survivors is needed, especially those at high risk of experiencing long COVID syndrome.

Latar belakang: Coronavirus Disease 2019 (COVID-19) merupakan penyakit yang sangat menular dan menjadi pandemi di seluruh dunia akibat infeksi Severe Acute Respiratory Syndrome Coronavirus (SARS-COV2). Pada pasien pasca infeksi COVID-19 sekitar 10% pasien tetap mengalami gejala hingga lebih dari tiga minggu dan kurang dari 10% pasien mengalami gejala sisa hingga berbulan-bulan. Pasien yang memiliki gejala sisa atau yang dikenal dengan sindrom long COVID dapat mengalami berbagai gangguan struktur dan fungsi tubuh. Tidak hanya pada saluran pernapasan, gejala sisa juga dapat terjadi pada beberapa organ seperti sistem kardiovaskular, muskuloskeletal dan sistem saraf bahkan psikologis.

Tinjauan kepustakaan: Rehabilitasi medik memiliki peran dalam meningkatkan kemampuan fungsional dan meningkatkan kualitas hidup pasien pasca infeksi COVID 19. Untuk mengetahui gangguan yang terjadi pada pasien pasca infeksi COVID-19 maka dibutuhkan screening dan assessment untuk menentukan tingkat keparahan yang dialami pada penyintas COVID-19. Pelayanan rehabilitasi yang diberikan sesuai dengan tingkat keparahan pasien pasca infeksi COVID 19. Terdapat tiga tingkatan model pelayanan rehabilitasi yang direkomendasikan yaitu pelayanan specialist multidisciplinary team (MDT), tim terapi berbasis komunitas, dan self-management.

Simpulan: Program rehabilitasi pada pasien pasca COVID 19 diberikan secara spesifik dan berbeda pada setiap individu tergantung dari tingkat keparahan dan gangguan fungsi yang dialami. Untuk itu diperlukan screening dan assessment pada penyintas COVID-19 terutama yang berisko tinggi mengalami sindrom long COVID.

Background: Caesarean section is one of the most frequently performed major surgical procedures worldwide. Peritoneal sutures in the cesarean section are performed via absorbable or delayed sutures. There is controversy over the choice of technique (continuous or interrupted) to close this layer, even among surgeons who believe in closing this layer. Overall, there are still differing opinions regarding the closure of this layer. This study examines how the study of the impact of peritoneal closure with no closure at the cesarean section on the risk of adhesions.
Methods: Systematic Literature Review Research is the method selected by researchers in this study. Researchers will describe facts, data and information obtained from literature studies such as books and journals to research results related to the research topic. The quality of the articles was reviewed based on PRISMA and PICO guidelines so that as many as 7 articles were synthesized in the final review report from the literature.
Results: It is known that the incidence of births worldwide by Caesarean section (CS) is increasing. Many births after CS have previously been performed by repeat surgery, either with elective CS or after an unsuccessful delivery attempt. The formation of these adhesions is associated with increased maternal morbidity in patients with recurrent CS. In studies, non-closure of the peritoneum appears to save time and costs and therefore lacks the adhesions that cause infertility. However, not closing the parietal peritoneum will cause adhesions without causing infertility. These adhesions can cause long operating times, recovery, and increased postoperative pain in the second cesarean section.
Conclusion: Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal lining in the cesarean section can provide benefits or not. Therefore it is necessary to evaluate whether this step should be omitted.

Background: Thoracic trauma it often causes ventilation perfusion disorders resulting in tissue oxygenation disorders that cause death. Rapid and systematic evaluation of the patient in the identification and treatment of injuries is essential for immediate recovery of the soul and further definitive treatment. Several factors have been studied to see arrest in increasing the risk of worsening of the condition in cases of blunt thoracic trauma.

Methods: A cross-sectional study with a prospective cohort design conducted by taking secondary data from questionnaire extraction data. Sampling was carried out at the Emergency Room (ER), Prof. Dr. I.G.N.G.Ngoerah Central General Hospital from April 2021 to April 2022. The independent variables studied included risk factors for worsening. The dependent variable includes a worsening of the condition characterized by the presence of ARDS (PaO2/FiO2 ≤ 300 mmHg), or PaO2/FiO2 ≤ 200 mmHg in patients who present with ARDS. Control variables include diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease, and cancer

Results: The study subjects were 69 children who met the criteria. Age more than or equal to 45 years, sex, oxygen saturation, changes in pH, contusions, bone fractures, infection, hemothorax, and pneumothorax are not risk factors for worsening in patients with blunt thoracic trauma at Prof. Dr. I.G.N.G.Ngoerah Central General Hospital. Only ARDS conditions and worsening of conditions had a meaningful relationship. The condition of ARDS when in the ER for worsening resulted in a relative risk value (RR) of 18.750 (p=0.001; 95% CI: 5.400-65.101).

Conclusion: Risk factors for aggravation in patients with blunt thoracic trauma ARDS

Latar belakang: Pada trauma thorax sering menyebabkan gangguan ventilasi perfusi sehingga terjadinya gangguan oksigenasi jaringan yang menyebabkan kematian. Evaluasi yang cepat dan sistematis pada pasien dalam mengidentifikasi dan penanganan cedera sangat penting untuk penyelamatan jiwa secara langsung dan penanganan definitif lebih lanjut. Beberapa faktor telah dipelajari untuk melihat perannya dalam meningkatkan risiko perburukan kondisi pada kasus trauma tumpul thorax.

Metode: Penelitian cross-sectional dengan desain kohort prospektif yang dilakukan dengan mengambil data sekunder dari kuisioner ekstrasi data. Pengambilan sampel dilakukan di Instalasi Gawat Darurat (IGD), Rumah Sakit Umum Pusat Prof. Dr. I.G.N.G.Ngoerah  pada Bulan April 2021 sampai dengan bulan April 2022. Variabel bebas yang diteliti meliputi faktor-faktor risiko perburukan. Variabel terikat meliputi perburukan kondisi yang ditandai oleh munculnya ARDS (PaO₂/FiO₂ ≤ 300 mmHg), atau PaO₂/FiO₂ ≤ 200 mmHg pada pasien yang datang dengan ARDS. Variabel kendali meliputi diabetes melitus, penyakit jantung coroner, penyakit paru obstruktif kronis, dan kanker

Hasil: Subyek penelitian sebanyak 79 sampel yang memenuhi kriteria. Usia lebih dari atau sama dengan 45 tahun, jenis kelamin, saturasi oksigen, perubahan pH, kontusio, fraktur kosta, infeksi, hemothorax, dan pneumothorax tidak merupakan faktor risiko terjadinya perburukan pada penderita trauma tumpul thorax di Rumah Sakit Umum Pusat Prof. Dr. I.G.N.G.Ngoerah. Hanya kondisi ARDS dan perburukan kondisi yang memiliki hubungan bermakna. Kondisi ARDS saat di UGD terhadap terjadinya perburukan menghasilkan nilai relative risk (RR) 18,750 (p=0,001;95%CI:5,400-65,101).

Kesimpulan: Faktor risiko terjadinya perburukan pada penderita trauma tumpul thorax meliputi ARDS

Background: Intracranial lesions can cause neuroophthalmological disorders in patients. This study aims to describe neuroophthalmological disorders due to intracranial lesions (optic chiasma) at the Optic Hospital of Prof. Dr. IGNG Ngoerah 2021-2022.

Methods: This type of research is a retrospective descriptive using medical record data in 2021 - 2022. The parameters assessed in this study were age, sex, hemianopsia, visual acuity, color vision impairment, optic nerve papillae atrophy, contrast sensitivity, cupping, and Relative Afferent Pupillary Defect (RAPD). Data were analyzed with SPSS version 23.0 for Windows.

Results: There were 22 patients with intracranial lesions in the Neuro-Ophthalmology Division, Ophthalmic Hospital, Prof. Dr. IGNG Ngoerah, during the study period. Most of the research subjects were male and were in the age group of 41-50 years. The most common complaint is blurred vision without other complaints. The most common type of visual field loss is bitemporal hemianopsia. The most visual acuity is 6/6-6/18, as much as 54.5%, while 25% of eyes have visual acuity <6-60. Nearly half of the eye samples (45.5%) had atrophic papillae and 8 eyes (18.2%) had cupping. A total of 9 eyes (20.5%) had impaired color vision, 28 eyes (63.6%) had impaired contrast sensitivity, and 2 eyes (4.5%) had positive RAPD.

Conclusion: There is a significant relationship between visual acuity, color vision impairment, and contrast sensitivity. There is no relationship between complaints of pain and the type of hemianopsia.

Latar Belakang: Lesi intrakranial dapat menyebabkan kelainan neuro oftalmologi pada pasien. Penelitian ini bertujuan untuk mengetahui gambaran kelainan neuro oftalmologi akibat lesi intrakranial (chiasma optikum) di Poliklinik Mata RSUP Prof. Dr. IGNG Ngoerah tahun 2021-2022.

Metode: Jenis penelitian adalah deskriptif retrospektif dengan menggunakan data rekam medik pada tahun 2021 - 2022. Parameter yang dinilai pada penelitian ini adalah usia, jenis kelamin, hemianopsia, tajam penglihatan, gangguan penglihatan warna, atrofi papil nervus optikus, sensitivitas kontras, cupping, dan Relative Afferent Pupillary Defect (RAPD). Data dianalisis dengan SPSS versi 23.0 untuk Windows.

Hasil: Terdapat 22 pasien Lesi Intrakranial di Divisi Neuro Oftalmologi Poli Mata RSUP Prof. Dr. IGNG Ngoerah selama periode penelitian. Subjek penelitian lebih banyak berjenis kelamin laki-laki dan berada pada kelompok usia 41-50 tahun. Keluhan yang paling sering terjadi adalah penglihatan kabur tanpa keluhan lainnya. Jenis gangguan lapang pandang yang paling sering dialami adalah hemianopsia bitemporal. Tajam penglihatan terbanyak adalah 6/6-6/18 sebanyak 54,5% sedangkan 25% mata memiliki tajam penglihatan <6-60. Hampir setengah sampel mata (45,5%) mengalami papil atrofi dan 8 mata (18,2%) mengalami cupping. Sebanyak 9 mata (20,5%) mengalami gangguan penglihatan warna, 28 mata (63,6%) mengalami gangguan sensitivitas kontras, dan 2 mata (4,5%) memiliki RAPD positif.

Kesimpulan: Terdapat hubungan bermakna antara tajam penglihatan dengan gangguan penglihatan warna dan sensitivitas kontras. Tidak terdapat hubungan antara keluhan nyeri dan jenis hemianopsia.

Background: Diffused otitis externa is an external ear infection in the form of ear pain and swelling of the ear canal with or without ear fluid. The most common bacteria that cause this infection are Staphylococcus aureus and Pseudomonas aeruginosa. Research using natural ingredients to treat infectious diseases has been done a lot. The binahong plant (Anredera cordifolia) is one of the interesting natural ingredients to study because of its potential as an antibacterial. This study aims to determine the antibacterial activity and active compounds of the ethanol extract of binahong leaves (Anredera cordifolia) against Staphylococcus aureus and Pseudomonas aeruginosa.

Methods: The method of this study was to test the antibacterial activity of alkaloids, flavonoids and saponins from binahong leaf extract against ATCC 9027 (Pseudomonas aeruginosa) and ATCC 25923 (Staphylococcus aureus) bacteria as the most common causes of diffuse otitis externa. Antibacterial activity was assessed using the Thin Layer Chromatography-Bioautography (TLC-Bioautography) immersion method using a clear area on a purple background on the TLC plate. This data was analyzed with SPSS version 23.0 for Windows.

Results: The mean measurement results of the Inhibitory Diameter Zone (IDZ) of binahong leaf extract (Anredera cordifolia) concentrations of 80%, 90% and 100% against ATCC 25923 bacteria were 7.80 mm, 8.00 mm and 9.60 mm respectively. In contrast, the mean diameter of inhibition (DDH) of binahong leaf extract (Anredera cordifolia) concentrations of 80%, 90% and 100% against ATCC 9027 bacteria was 0.00 mm. Thin Layer Chromatography (TLC)-Bioautography test MTT method of binahong leaf extract on Staphylococcus aureus (ATCC 25923) showed clear areas with a purple background in alkaloids and saponins.

Conclusion: The active compounds of binahong leaf extract (Anredera cordifolia), which inhibit the growth of Staphylococcus aureus bacteria, are alkaloids and saponins.

Latar Belakang: Otitis eksterna difusa adalah infeksi telinga luar berupa nyeri telinga dan pembengkakan liang telinga dengan atau tanpa disertai cairan telinga. Bakteri tersering penyebab infeksi ini adalah Staphylococcus aureus dan Pseudomonas aeruginosa. Penelitian menggunakan bahan alam untuk mengatasi penyakit infeksi telah banyak dilakukan. Tanaman binahong (Anredera cordifolia) menjadi salah satu bahan alam yang menarik untuk diteliti karena potensinya sebagai antibakteri. Penelitian ini bertujuan mengetahui aktivitas antibakteri dan senyawa aktif ekstrak etanol daun binahong (Anredera cordifolia) terhadap Staphylococcus aureus dan Pseudomonas aeruginosa.

Metode: Metode penelitian ini adalah pengujian aktivitas antibakteri golongan senyawa alkaloid, flavonoid dan saponin dari ekstrak daun binahong terhadap bakteri ATCC 9027 (Pseudomonas aeruginosa) dan ATCC 25923 (Staphylococus aureus) sebagai penyebab tersering otitis eksterna difusa. Aktivitas antibakteri dinilai berdasarkan uji Kromatografi Lapis Tipis- Bioautografi (KLT-Bioautografi) metode imersi berupa adanya daerah bening diatas latar belakang ungu pada plat KLT. Data ini dianalisis dengan SPSS versi 23.0 untuk Windows.

Hasil: Hasil pengukuran rerata Diameter Daya Hambat (DDH) ekstrak daun binahong (Anredera cordifolia) konsentrasi 80%, 90% dan 100% terhadap bakteri ATCC 25923 berturut-turut adalah 7,80 mm, 8,00 mm dan 9,60 mm. Sedangkan rerata diameter daya hambat (DDH) ekstrak daun binahong (Anredera cordifolia) konsentrasi 80%, 90% dan 100% terhadap bakteri ATCC 9027 adalah 0,00 mm. Uji Kromatografi Lapis Tipis (KLT)-Bioautografi metode MTT ekstrak daun binahong pada bakteri Staphylococcus aureus (ATCC 25923) menunjukkan adanya daerah bening dengan latar belakang ungu pada senyawa alkaloid dan saponin.

Kesimpulan: Senyawa aktif ekstrak daun binahong (Anredera cordifolia) yang berperan dalam mengahmbat pertumbuhan bakteri Staphylococcus aureus adalah senyawa alkaloid dan saponin.

Background: The Covid-19 pandemic has reportedly resulted in increased layoffs in Indonesia, which has affected people's income. This can lead to a decrease in food purchasing ability, decreasing children's nutritional intake. Furthermore, the first thousand days of life is a critical period that determines the health and welfare of children. This study aimed to determine the relationship between family income during the Covid-19 pandemic and the nutritional status of infants aged 0-2 years at the Dawan I Community Health Center, Dawan District, Klungkung Regency.

Method: This cross-sectional study used infants aged 0-24 months as study subjects, with the respondents being housewives with toddlers aged 0-24 months who were selected according to the study inclusion criteria. Nutritional status and family income were obtained using secondary data, interviews and filling out questionnaires. Data analysis was performed with SPSS v.21 with a p-value ≤0.05.

Results: A total of 80 respondents were obtained as study subjects. Most of the parents were >25 years old (61 respondents; 76.3%) with senior high school education (46 respondents; 57.5%). Most respondents did not work (34 respondents; 42.5%) with family income < Rp. 2,538,000.00 (53 respondents; 66.3%). Most babies have good nutritional status (38 respondents; 47.5%). Based on bivariate analysis, a significant relationship exists between family income and infant nutritional status (chi-square; p=0.008; two-tailed).

Conclusion: There is a significant relationship between family income during the Covid-19 pandemic and the nutritional status of infants aged 0-2 years at the Dawan I Health Center, Dawan District, Klungkung Regency.

Latar Belakang: Pandemi Covid-19 dilaporkan telah mengakibatkan peningkatan angka pemutusan hubungan kerja (PHK) di Indonesia, khususnya di Bali yang berpengaruh terhadap pendapatan masyarakat. Hal ini dapat menyebabkan penurunan daya beli pangan yang berakibat pada penurunan asupan gizi anak. Terlebih lagi, seribu hari pertama kehidupan (1000 HPK) merupakan masa kritis yang menentukan kesehatan dan kesejahteraan anak. Penelitian ini bertujuan untuk mengetahui hubungan antara pendapatan keluarga pada masa pandemi Covid-19 terhadap status gizi bayi usia 0-2 tahun di Puskesmas Dawan I Kecamatan Dawan Kabupaten Klungkung.

Metode: Penelitian ini merupakan studi observasional analitik dengan desain potong lintang. Subjek penelitian adalah bayi usia 0-24 bulan yang tercatat pada Laporan Bulanan Gizi Puskesmas Dawan I Kecamatan Dawan, Kabupaten Klungkung, dengan responden penelitian ini adalah ibu rumah tangga anak balita usia 0-24 bulan sesuai kriteria penelitian. Status gizi dan pendapatan keluarga diperoleh menggunakan data sekunder, wawancara, dan pengisian kuesioner. Analisis data dilakukan dengan SPSS v.21 dengan nilai p≤0,05 dianggap signifikan secara statistik.

Hasil: Sebanyak 80 responden diperoleh sebagai subjek penelitian. Sebagian besar orang tua berusia >25 tahun (61 responden; 76,3%) dengan pendidikan terakhir SMA (46 responden; 57,5%). Sebagian besar responden tidak bekerja (34 responden; 42,5%) dengan pendapatan keluarga < Rp. 2.538.000,00 (53 responden; 66,3%). Sebagian besar bayi memiliki status gizi baik (38 responden; 47,5%). Berdasarkan analisis bivariat, terdapat hubungan signifikan antara pendapatan keluarga dan status gizi bayi (chi-square; p=0,008; two-tailed).

Simpulan: Terdapat hubungan signifikan antara pendapatan keluarga pada masa pandemi Covid-19 terhadap status gizi bayi usia 0-2 tahun di Puskesmas Dawan I Kecamatan Dawan Kabupaten Klungkung.

Background: Nasopharyngeal Carcinoma (NPC) is a tumor or malignancy that manifests in the nasopharynx, in the upper throat and back of the nose. When someone is diagnosed with cancer, many of them experience mental disorders, such as one example of depression. This study aimed to determine the relationship between early and advanced clinical stages with the incidence of depression in nasopharyngeal carcinoma patients before therapy.

Methods: An observational cross sectional comparative study design was conducted. Fifty-four research subjects were obtained with consecutive sampling techniques. The data obtained were analyzed descriptively, followed by the Chi-Square test and ended with the Logistic Regression test by SPSS version 26.0 for Windows.

Results: Based on bivariate analysis, three variables are significantly related to the level of depression in NPC patients, such as age, level of education and stage of cancer (p<0.05). Based on multivariate analysis using Logistic Regression, only one variable had a statistically significant relationship with the level of depression in NPC patients, namely the cancer stadium variable (p=0.001).

Conclusion: These findings suggest a significant relationship between the stage of cancer and the level of depression in NPC patients.

Latar Belakang: Karsinoma Nasofaring (KNF) adalah tumor atau keganasan yang bermanifestasi pada daerah nasofaring yaitu pada daerah atas tenggorokan dan belakang hidung. Ketika seseorang didiagnosa menderita kanker,banyak yang mengalami gangguan mental seperti salah satu contohnya depresi. Tujuan penelitian ini adalah untuk mengetahui hubungan stadium klinis awal dan lanjut dengan kejadian depresi pada pasien karsinoma nasofaring sebelum terapi.

Metode: observasional dengan rancangan cross sectional comparative study. Didapatkan 54 subjek penelitian dengan tehnik consecutive sampling. Data yang diperoleh dianalisis secara deskriptif, dilanjutkan dengan uji Chi-Square dan diakhiri uji Regresi Logistik menggunakan SPSS versi 26.0 untuk Windows.

Hasil: Berdasarkan analisis bivariat, terdapat tiga variabel yang berhubungan secara bermakna dengan tingkat deprersi pada pasien KNF yakni usia, tingkat pendidikan terakhir dan stadium kanker (p<0.05). Berdasarkan analisis multivariat dengan menggunakan Regresi Logistik hanya terdapat satu variabel yang secara statistik memiliki hubungan bermakna dengan tingkat depresi pada pasien KNF yaitu variabel stadium kanker (p=0.001).

Kesimpulan: Hasil penelitian ini menunjukkan bahwa terdapat hubungan yang bermakna antara stadium kanker dengan tingkat depresi pada pasien KNF.

Background: Indonesia is a tropical country with numerous cases of infectious diseases, and one of the causes is fungal infections. Fungal infections on the hair and scalp are known as tinea capitis. Up-to-date epidemiological data is essential for guiding diagnosis and therapy. Therefore, regular reports from each healthcare center are necessary.

Method: This study is a retrospective cross-sectional study that utilizes secondary data from all patients with tinea capitis in the Skin and Venereal Disease Clinic during the period of January 2014 to 2019. Data analysis was conducted using SPSS version 25.0 to perform univariate analysis.

Results: There were 42 cases of tinea capitis during the study period. The cases were predominantly found in males (61.9%) and the age group of 6-18 years (59.5%). The most commonly encountered type of tinea capitis was gray patch (78.6%) with negative Wood's lamp findings (90.5%) and ectothrix spores (54.8%). The common pathogens identified were Trichophyton tonsurans, Trichophyton mentagrophyte, and Microsporum audouinii.

Conclusion: There was fluctuation in the number of cases from 2014 to 2019, with a tendency towards an increase. The majority of tinea capitis patients were males in the age group of 6-18 years. Gray patch was the most common type of tinea capitis, and the most prevalent pathogens were Trichophyton tonsurans, Trichophyton mentagrophyte, and Microsporum audouinii, respectively.

Latar Belakang: Indonesia merupakan negara tropis yang memiliki banyak kasus penyakit infeksi dan jamur merupakan salah satu penyebabnya. Infeksi jamur pada rambut dan kulit kepala dikenal sebagai tinea kapitis. Data epidemiologi terkini sangat bermanfaat untuk mengarahkan diagnosis serta terapi. Oleh sebab itu, dibutuhkan laporan secara berkala dari masing-masing pusat layanan kesehatan.

Metode: Studi ini merupakan studi retrospektif cross sectional yang menggunakan data sekunder dari seluruh pasien tinea kapitis di Poliklinik Kulit dan Kelamin pada periode Januari 2014-2019. Analisis data menggunakan SPSS versi 25.0 untuk melakukan analisis univariat.

Hasil: Terdapat 42 kasus tinea kapitis selama periode penelitian. Kasus didominasi oleh laki-laki (61,9%) dan kelompok usia 6 – 18 tahun (59,5%). Tipe tinea kapitis yang paling banyak dijumpai adalah gray patch (78,6%) dengan hasil temuan lampu Wood negatif (90,5%), dan spora ektotrik (54,8%). Patogen yang umum dijumpai adalah Trichophyton tonsurans, Trichophyton mentagrophyte, serta Microsporum audouinii.

Kesimpulan: Terjadi fluktuasi pada tahun 2014 hingga 2019 dengan kecenderungan peningkatan kasus. Sebagian besar pasien tinea kapitis adalah laki-laki dan kelompok usia 6 – 18 tahun. Gray patch merupakan tipe tinea kapitis yang paling umum dan patogen terbanyak adalah Trichophyton tonsurans, Trichophyton mentagrophyte, serta Microsporum audouinii, secara berurutan.

Background: In Indonesia, diabetes is the third most common cause of death after stroke and ischemic heart disease in 2019. The prevalence of diabetes has increased by approximately 49.9% since 2009. Anemia is a common complication of diabetes and has been identified as a risk factor for cardiovascular disease and end-stage renal disease in diabetic patients. Even so, approximately 25% of anemia in patients with type 2 diabetes mellitus (T2DM) is still not recognized.

Methods: This research is an observational analytic study with a cross-sectional research method. The data were taken from the patient's medical records using the consecutive sampling technique. The subjects of this study were T2DM patients registered at Prof. Dr. I.G.N.G. Ngoerah General Hospital from January 2019 to December 2021. Data that comply with the inclusion and exclusion criteria are then processed with SPSS version 20.0 for Windows.

Results: This study found that 28.9% of T2DM patients at Prof. Dr. I.G.N.G. Ngoerah General Hospital suffered from anemia. Most T2DM patients with anemia came from 50-59 years and 60-69 years (34.6%) and were male (69.2%). The most frequent type of anemia was the normochromic normocytic type (76.9%). When viewed from the severity, the most common anemia found was mild anemia (88.5%).

Conclusion: Compared to the general population, T2DM patients have a higher risk of anemia. Anemia in T2DM can also trigger and worsen complications. Therefore, early detection and management of anemia are needed in T2DM patients.

Latar Belakang: Di Indonesia, diabetes merupakan penyebab kematian terbanyak ketiga setelah stroke dan penyakit jantung iskemik pada tahun 2019. Prevalensi diabetes meningkat sebanyak kira-kira 49,9% dari tahun 2009. Anemia merupakan komplikasi diabetes yang umum ditemukan, dan telah diidentifikasi sebagai faktor risiko dari penyakit kardiovaskular serta penyakit ginjal stadium akhir pada pasien diabetes. Meski begitu, kurang lebih 25% anemia pada penderita diabetes melitus tipe 2 (DMT2) masih tidak dikenali.

Metode: Penelitian ini merupakan penelitian analitik observasional dengan metode penelitian cross-sectional. Data diambil dari rekam medis pasien dengan teknik pengambilan sampel secara konsekutif. Subjek penelitian ini adalah pasien DMT2 yang terdaftar di RSUP Prof. Dr. I.G.N.G. Ngoerah pada Januari 2019 hingga Desember 2021. Data yang sesuai kriteria inklusi dan eksklusi kemudian diolah dengan SPSS versi 20.0 untuk Windows.

Hasil: Pada studi ini ditemukan bahwa 28,9% pasien DMT2 di RSUP Prof. Dr. I.G.N.G. Ngoerah menderita anemia. Pasien DMT2 dengan anemia kebanyakan berasal dari kelompok usia 50-59 tahun dan 60-69 tahun (keduanya 34,6%), dan berjenis kelamin laki-laki (69,2%). Tipe anemia yang paling banyak muncul yaitu tipe normokromik normositer (76,9%). Apabila dilihat dari derajatnya, anemia yang paling banyak diderita adalah anemia ringan (88,5%).

Kesimpulan: Jika dibandingkan dengan populasi umum, pasien DMT2 memiliki risiko lebih tinggi untuk menderita anemia. Anemia pada DMT2 juga dapat memacu serta memperburuk komplikasi. Oleh karena itu, deteksi dini dan manajemen anemia sangat diperlukan pada pasien DMT2.

Background: Based on data from Basic Health Research for Bali province in 2018, Denpasar is a city that has the highest prevalence of chronic energy deficiency (CED) among young women in the Bali province. The purpose of this research is to determine the relationship between physical activity and energy consumption levels with CED in young women in Pemecutan Klod Village, West Denpasar.

Method: This research is an analytical research with a cross-sectional survey design. The sample of this research is 92 samples. The sample determination method used is Cluster Sampling by selecting five banjars. Data about CED status was carried out by measuring the circumference of the upper arm. Data about physical activity was collected using a physical activity questionnaire. Energy consumption level data was collected using the SQ-FFQ questionnaire. Analysis of the data used is Rank Spearman correlation test with α = 0.05.

Results: Most of the samples have a strenuous level of physical activity as many as 13% moderate physical activity level as many as 66,3% and light physical activity level as many as 20,7%. Based on the level of energy consumption it was found that 52,2% have a deficit energy consumption level, 2,2% have a good energy consumption level, and 45,7% have a low energy consumption level. Most of the samples were in CED conditions as many as 56,5% while the rest were not in CED conditions as many ad 43,5%

Conclusion: There is a significant relationship between physical activity and the level of energy consumption with CED in young women in Pemecutan Klod Village, West Denpasar District.

Latar Belakang: Berdasarkan data Riset Kesehatan Dasar Provinsi Bali tahun 2018, Kota Denpasar merupakan kota yang memiliki prevalensi remaja putri dengan kondisi kekurangan energi kronis (KEK) tertinggi di Provinsi Bali. Penelitian ini bertujuan untuk mengetahui hubungan aktivitas fisik dan tingkat konsumsi energi dengan kejadian kurang energi kronis pada remaja putri di Desa Pemecutan Klod Kecamatan Denpasar Barat.

Metode: Penelitian ini merupakan penelitian analitik dengan rancangan survei cross-sectional. Sampel penelitian ini berjumlah 92 sampel. Metode penentuan sampel yang digunakan yaitu cluster sampling dengan memilih lima banjar. Data status KEK dikumpulkan dengan pengukuran lingkar lengan atas. Data aktivitas fisik dikumpulkan menggunakan kuisioner aktivitas fisik. Data tingkat konsumsi energi dikumpulkan menggunakan kuesioner Semi Quantitative Food Frequency Questionnaire (SQ-FFQ). Data dianalisis dengan uji korelasi Rank Spearman dengan α = 0,05.

Hasil: Sebagian besar sampel memiliki tingkat aktivitas fisik yang berat yaitu sebanyak 13%, tingkat aktivitas fisik sedang sebanyak 66,3% serta tingkat aktivitas fisik ringan sebanyak 20,7%. Tingkat konsumsi energi sampel sebanyak 52,2% memiliki tingkat konsumsi energi defisit, tingkat konsumsi energi baik sebanyak 2,2% serta tingkat konsumsi energi kurang sebanyak 45,7%. Sebagian besar sampel dalam kondisi KEK sebanyak 56,5% sedangkan tidak dalam kondisi KEK sebanyak 43,5%.

Simpulan: Terdapat hubungan yang signifikan antara aktivitas fisik dan tingkat konsumsi energi dengan kejadian KEK pada remaja putri di Desa Pemecutan Klod Kecamatan Denpasar Barat.

Introduction: Currently the Internet is an important part of student learning. The internet provides information that is one of the main sources of reference in understanding medical science. The information available on the internet varies over a wide area. Not all of this information can be used as a reference. This study aimed to describe the use of online medical and drug information among university students.

Method: This study used a descriptive cross-sectional research design. Data was collected through a questionnaire conducted online with active students of the Undergraduate Medicine Study Program, Faculty of Medicine, Udayana University, Class of 2019-2022 during the January-March 2023 period.

Results: The number of students who became respondents included 301 people. Most of the respondents (86.14%) have known the internet as a source of medical and drug information for more than 1 year and the devices that are widely used are laptops and mobile phones (85,72% and 87.38%). The frequency is at most once a week (56.82%), and the duration is less than 2 hours (57.81%). Almost all respondents feel that digital information plays a very influential role in medical practice and have utilized electronic journal databases (89,04%). The most frequently used journals are Google Scholar (87,05%) and Pubmed (84.72%). The largest drug database is the official BPOM website (64.46%). Lecturer recommendations are the most common source (55.82%). Most of the reasons were lecture assignments (90,04%) with the most searched topics being information about management (86.72%) and drug dosages (86,05%).

Conclusion: Utilization of online medical and drug information has a big role in student learning activities. Based on this, the availability of access to information in reputable scientific journals will be needed.

Pendahuluan: Saat ini internet menjadi bagian penting dalam pembelajaran mahasiswa. Internet menyediakan informasi yang menjadi salah satu sumber referensi utama dalam memahami ilmu kedokteran. Informasi yang tersedia dalam internet beragam dengan area yang luas. Tidak semua informasi dapat dimanfaatkan sebagai referensi. Penelitian ini bertujuan untuk mendeskripsikan pemanfaatan informasi medis dan obat secara online di kalangan mahasiswa kedokteran.

Metode: Penelitian ini menggunakan rancangan penelitian potong lintas dengan deskriptif analitik. Data dikumpulkan melalui kuesioner yang dilakukan secara daring terhadap mahasiswa aktif Program Studi Sarjana Kedokteran Fakultas Kedokteran Universitas Udayana Angkatan 2019-2022 selama periode Januari-Maret 2023.

Hasil: Jumlah mahasiswa yang menjadi responden mencakup 301 orang. Sebagian besar responden (86,14%) sudah mengenal internet sebagai sumber informasi medis dan obat lebih dari 1 tahun serta perangkat yang banyak digunakan adalah laptop dan mobile phone (85,72% dan 87,38%). Frekuensi paling banyak satu kali seminggu (56,82%), dan durasi yang dihabiskan selama kurang dari 2 jam (57,81%). Hampir keseluruhan responden merasakan peran informasi digital sangat berpengaruh dalam praktik kedokteran dan sudah memanfaatkan database jurnal elektronik (89,04%). Jurnal paling sering digunakan adalah Google Scholar (87,05%) dan Pubmed (84,72%). Basis data obat terbanyak adalah situs resmi BPOM (64,46%). Rekomendasi dosen adalah sumber terbanyak (55,82%). Alasan terbanyak adalah tugas perkuliahan (90,04%) dengan topik yang paling banyak ditelusuri adalah informasi mengenai manajemen (86,72%) dan dosis obat (86,05%).

Simpulan: Pemanfaatan informasi medis dan obat secara online memiliki peran besar dalam kegiatan pembelajaran mahasiswa. Didasari hal tersebut, ketersediaan akses informasi jurnal-jurnal ilmiah bereputasi akan sangat dibutuhkan.

Introduction: Acute respiratory infection (ARI) is still a major health problem in Indonesia. Parents' smoking habit is a risk factor for the incidence of ARI in children under five. This study aims to assess the relationship between the incidence of ISPA in toddlers and the smoking habits of parents who come to the Manggar Health Center.

Methods: This descriptive observational study was conducted using a cross-sectional method in the period February - March 2022 at PKM Manggar. The independent variable includes the degree of parental smoking behavior. While the dependent variable is the visit of pediatric patients with a diagnosis of ISPA.

Results: Fifty visits of toddler patients during the study period were dominated by ARI patients (52%). As many as 64% of patients were passive smokers with 62% getting exposure to cigarette smoke of more than 5 cigarettes per day. Most of the patients were males with normal birth weight and aged between 2-5 years.

Conclusion: Further analytical exploration to determine the relationship between parents' smoking habits and the incidence of ARI in toddlers is needed.

Pendahuluan: Infeksi saluran pernapasan akut (ISPA) masih menjadi masalah kesehatan besar di Indonesia. Kebiasaan merokok orang tua merupakan faktor risiko kejadian ISPA pada balita. Penelitian ini bertujuan untuk menilai hubungan kejadian ISPA pada balita dengan kebiasaan merokok orang tua yang datang ke Puskesmas Manggar .

Metode: Penelitian observasional deskriptif ini dilakukan menggunakan metode potong lintang pada periode Februari - Maret 2022 di PKM Manggar. Variabel bebas meliputi derajat perilaku merokok orang tua. Sementara variabel terikat adalah kunjungan pasien anak dengan diagnosis ISPA.

Hasil: Lima puluh kunjungan pasien balita selama periode penelitian didominasi oleh pasien ISPA (52%). Sebanyak 64% pasien merupakan perokok pasif dengan 62% mendapatkan pajanan asap rokok lebih dari 5 batang per hari. Sebagian besar pasien adalah laki-laki dengan berat badan lahir normal dan berusia antara 2-5 tahun.

Kesimpulan: Eksplorasi lebih lanjut secara analitik untuk mengetahui hubungan antara kebiasaan merokok orang tua dan kejadian ISPA pada balita diperlukan.

Background: Inflammatory indicators such as alterations in neutrophils, platelets, and lymphocytes are linked to the acute coronary syndrome. This research seeks to understand the association of the Platelet Lymphocyte Ratio (PLR) and Neutrophil-Lymphocyte Ratio (NLR) with the Grace score as well as the association between NLR and PLR with High Sensitivity Troponin T (hs-cTnT) as a serum biomarker that aids in ACS diagnosis.

Methods: The 99 patients who met the inclusion criteria for this study were the subject of an analytical investigation with a retrospective cross-sectional design. Based on the ratio of lymphocytes to neutrophils, NLR is determined. Based on the ratio of platelets to lymphocytes, PLR is determined. hs-cTnT laboratory samples were collected more than three hours after the ischemia complaint first manifested, using the Grace risk score as a predictor of mortality. Using SPSS program 25.0, data were examined.

Results: Bivariate analysis using the Spearman correlation test. There is a correlation between NLR and GRACE risk scores (r=0.348; p<0.001), PLR and GRACE risk scores (r=0.434; p<0.001), NLR and hs-cTnT (r=0.343; p=0.001), PLR and hs-cTnT (r=0.284; p=0.004). ROC curve analysis, NLR cut-off value 4.45 (sensitivity 73.3%; specificity 72.6%), and PLR cut-off value 139.77 (sensitivity 66.7%; specificity 59.5 %) to detect High grace score. NLR cut-off value 2.17 (sensitivity 62.9%; specificity 60 %), and PLR cut-off value 108.38 (sensitivity 60.7%; specificity 60 %) to detect High hs-cTnT.

Conclusion: In this study, there was a relationship between NLR and PLR with the Grace risk score as well as a relationship between NLR and PLR with hs-cTnT.

Background: Developmental delay was still a challenging issue especially in high risk infants. Multifactorial reasoning in neonatal history has led to the screening test as an important step to detect suspicion of any developmental delay. The suspicion was made based on the Denver II screening test, that could lead us to such conditions earlier. Determined prevalence and associated factors of developmental delay suspicion in high risk infants were needed to be investigated further. This study aimed to determine prevalence and associated factors of developmental delay suspicion based on the Denver II screening test in high risk infants.

Methods: This was an observational analytic study using a cross-sectional design. Data were collected from the Denver II screening test of infants aged below 12 months whose history of being treated in level II and III neonatal units, who visited outpatient clinics in July 2015 until June 2017.

Results: A total of 197 subjects were conducted in this study. It was dominated by male (58.9%), aged below 6 months (82.7%) with mean age was 77 days, term babies (56.8%), and spontaneous vaginal delivery (55.8%). Prevalence developmental delay suspicion in high risk infants was 46.2%. Significant associated factors were asphyxia and neonatal sepsis [OR=6.88 (CI 95% 3.39-13.94), p=0.00], [OR=2.36 (CI 95% 1.13-4.95), p=0.02].

Conclusion: Almost half of subjects had developmental delay suspicion based on Denver II screening test, with asphyxia and neonatal sepsis were significant associated factors. Further investigation and periodic evaluation were needed to confirm developmental issues in high risk infants.

Latar belakang: Gangguan perkembangan masih sering ditemui terutama pada bayi dengan risiko tinggi. Bayi tersebut memiliki alasan rawat yang bersifat multifaktorial, sehingga uji tapis keterlambatan perkembangan menjadi langkah awal yang penting. Kecurigaan keterlambatan tersebut dinilai menggunakan  uji tapis Denver II yang dapat mengarahkan kecurigaan gangguan tersebut lebih awal. Prevalens kecurigaan keterlambatan perkembangan dan faktor yang berhubungan dengan hasil tersebut pada bayi risiko tinggi perlu dinilai lebih lanjut. Penelitian ini bertujuan untuk mengetahui prevalensi serta menilai faktor yang berhubungan dengan kecurigaan keterlambatan perkembangan pada bayi risiko tinggi.

Metode: Penelitian ini merupakan penelitian analitik observasional menggunakan rancangan potong lintang. Data diambil dari hasil uji tapis Denver II terhadap bayi berusia di bawah 12 bulan yang memiliki riwayat perawatan neonatus level II dan III, yang melakukan kontrol poliklinik pada Juli 2015 hingga Juni 2017.

Hasil: Sebanyak 197 subjek yang diikutsertakan dalam penelitian ini. Subjek didominasi oleh jenis kelamin lelaki (58,9%), berusia di bawah 6 bulan (82,7%) dengan rerata usia 77 hari, usia gestasi cukup bulan (56,8%), dan persalinan spontan (55,8%). Prevalens kecurigaan keterlambatan perkembangan pada bayi risiko tinggi adalah 46,2%. Faktor yang berhubungan secara signifikan adalah asfiksia dan sepsis neonatorum dengan nilai [OR=6,88 (IK 95% 3,39-13,94), p=0,00], [OR=2,36 (IK 95% 1,13-4,95), p=0,02].

Simpulan: Hampir separuh subjek dicurigai mengalami keterlambatan perkembangan pada uji tapis Denver II, dengan asfiksia dan sepsis neonatorum sebagai faktor yang berhubungan secara signifikan. Penelitian lebih lanjut dan pengamatan berkala diperlukan untuk memastikan gangguan perkembangan pada bayi dengan risiko tinggi.

Background: Elderly is one of the risk groups for periodontal disease, one of which is gingivitis. This study aimed to identify the relationship between betel chewing habits and the incidence of gingivitis among elderly in the Kintamani VI Health Center.

Methods: A quantitative analytical research design with a cross-sectional approach was used in this study, involving about 134 elderly respondents aged 55 years and over in the Kintamani VI Public Health Center. The variabels measured in this study included the characteristics of the elderly (age, gender, occupation, and income), the incidence of gingivitis, betel chewing habits, the habit of brushing teeth and rinsing with antiseptiks, and knowledge related to gingivitis.

Results: The results of the analysis showed that most of the incidence of gingivitis was found in the male group, aged between 75 to 90 years, worked as traders/entrepreneurs, earned more than the regional minimum wage Bangli Regency (IDR 2,516,917), had betel chewing habits, had less knowledge, not regularly brushing teeth every day, and not gargling with antiseptik liquid. The proportion of respondents who had betel chewing habit was 43.3% and 61.9% had gingivitis. In addition, the betel chewing habit can increase the risk of gingivitis up to 3,269 times and earning more than the regional minimum wage is at risk of experiencing gingivitis by 3,618 times.

Conclusion: Health promotion to the elderly group and their families is very important to increase awareness that brushing teeth properly and correctly can prevent gingivitis and good for oral and dental health.

Latar Belakang: Lansia merupakan salah satu kelompok berisiko untuk terkena penyakit periodontal, salah satunya adalah gingivitis. Penelitian ini bertujuan untuk mengidentifikasi hubungan kebiasaan menginang dengan kejadian gingivitis pada lansia di wilayah kerja Puskesmas Kintamani VI.

Metode: Rancangan penelitian analitik kuantitatif dengan pendekatan crosssectional digunakan dalam penelitian ini, dengan melibatkan 134 responden lansia yang berusia 55 tahun ke atas di wilayah kerja Puskesmas Kintamani VI. Variabel yang diukur pada penelitian ini meliputi karakteristik lansia (usia, jenis kelamin, pekerjaan, dan penghasilan), kejadian gingivitis, kebiasaan menginang, kebiasaan gosok gigi dan berkumur dengan antiseptik, dan pengetahuan terkait gingivitis.

Hasil: Hasil analisis menunjukkan bahwa sebagian besar kejadian gingivitis ditemukan pada kelompok laki-laki, berusia antara 75 hingga 90 tahun, bekerja sebagai pedagang/wiraswasta, berpenghasilan lebih dari UMK Kabupaten Bangli (Rp. 2.516.917), memiliki kebiasaan menginang, memiliki pengetahuan yang kurang, tidak rutin gosok gigi setiap hari, dan tidak berkumur dengan cairan antiseptik. Proporsi responden yang menginang adalah 43,3% dan sebanyak 61,9% mengalami gingivitis. Selain itu, kebiasaan menginang dapat meningkatkan risiko terkena gingivitis hingga 3,269 kali serta berpenghasilan lebih dari UMK berisiko mengalami gingivitis sebesar 3,618 kali.

Kesimpulan: Promosi kesehatan kepada kelompok lansia dan keluarganya sangat penting dilakukan untuk meningkatkan kesadaran bahwa gosok gigi yang baik dan benar dapat mencegah terjadinya gingivitis serta bermanfaat untuk menjaga kesehatan gigi dan mulut.

Background: For pediatric patients who are hospitalized, full feeding nutritional needs is not only to improve BMI but also very useful for accelerating the healing process, shortening the treatment period, reducing complications, reducing morbidity and mortality, and preventing malnutrition due to treatment or medical action. This study aimed to describe the association between the achievement of full feeding with mortality in children.

Method: The retrospective study was conducted in Pediatric Ward at Sanglah General Hospital, Denpasar Bali period January to December 2021. The inclusion criteria in this study were all pediatric patients who were hospitalized at pediatric wards Sanglah Hospital Denpasar. Inclusion criteria were children aged 1 month-18 years old. Samples were taken by total sampling. Quantitative variables were tested using variables that scale categorical data will be displayed in the form of absolute numbers and percent. The results of the descriptive analysis are presented using a chi-square test used to analyze all indirect variables (depending on whether the assumptions were met). The results of multivariate analysis were  with logistic regression. The results were considered statistically significant at p < 0.05.

Result: Total 258 subjects who met the inclusion criteria. Multivariate analysis with logistic regression shows full feeding (Exp B 0.24; 95% CI 0.032-0.27; P 0.006), nutritional status (Exp B 0.23; 95% CI 0.31-1.55; P 0,004) was statistically significant for mortality.

Conclusion: Full feeding and nutritional status were associated with an increase in child mortality.

Introduction: Vascular access with non-tunneled and tunneled hemodialysis catheters in patients with chronic kidney disease can cause complications such as neointimal hyperplasia. Creating vascular access will cause injury to the endothelium and its underlying layer, which in turn will cause a series of inflammatory reactions. This study was conducted to determine the initial response of neointimal hyperplasia in blood vessels after vascular access in chronic kidney disease by increasing the monocyte lymphocyte ratio, neutrophil lymphocyte ratio, and platelet lymphocyte ratio after insertion of tunneled and non-tunneled catheters.

Methods: The research method is observational analysis with a retrospective cohort design. Sampling was taken using the consecutive sampling method in adult patients with chronic kidney failure who were inserted with tunneled and non-tunneled hemodialysis catheters at Prof. Dr. General Hospital, I.G.N.G. Ngoerah Denpasar. The statistical test uses paired T-test and unpaired T-test with a significance level of 0.05.

Results: A significant difference was found in the value of the neutrophil-lymphocyte ratio in tunneled hemodialysis catheters (mean difference: 0.51; 95% CI: -0.89–(-0.13); p value: 0.01) and non-tunneled (mean difference: 0.04; 95% CI: -0.08–(-0.001); p-value: 0.043). There was no significant difference in the monocyte-lymphocyte ratio after and before insertion of the tunneled hemodialysis catheter (mean difference: 0.04; 95% CI: -0.003–0.81; p value: 0.07) or non-tunneled (median difference: 0.06; p: 0.925). There was a statistically significant difference in the mean platelet-lymphocyte ratio after and before insertion of the tunneled hemodialysis catheter (mean difference: 32.24; 95% CI: -54.11–(-10.38); p-value: 0.005), but no significant difference was found in the placement of non-tunnelled hemodialysis catheters (mean difference: 26.24; 95% CI: -61.47–9.0; p value: 0.14).

Conclusion: There were differences in the inflammatory response after and before the insertion of tunneled and non-tunneled hemodialysis catheters, especially in the value of the neutrophil-lymphocyte ratio.

Pendahuluan: Akses vaskular dengan pemasangan kateter hemodialisa non tunnelled  dan tunnelled  pada pasien penyakit ginjal kronis dapat menimbulkan komplikasi seperti neointimal hiperplasia. Tindakan pembuatan akses vaskuler akan menyebabkan cedera pada endotel dan lapisan dibawahnya yang selanjutnya akan menyebabkan rangkaian reaksi inflamasi. Penelitian ini dilakukan untuk mengetahui respon awal neointimal hiperplasia pada pembuluh darah yang dilakukan pemasangan akses vaskuler pada penyakit ginjal kronis melalui peningkatan nilai rasio monosit limfosit, rasio neutrofil limfosit, dan rasio trombosit limfosit setelah pemasangan kateter tunnelled dan non tunnelled.

Metode: Metode penelitian berupa analitik observasional dengan rancangan kohort retrospektif. Pengambilan sampel dengan metode consecutive sampling, pada pasien dewasa dengan gagal ginjal kronis yang dilakukan insersi kateter hemodialisis tunnelled dan non-tunnelled di RSUP Prof Dr. I.G.N.G Ngoerah Denpasar. Uji statistic menggunakan Uji T-berpasangan dan Uji T-tidak berpasangan dengan tingkat kemaknaan α=0.05.

Hasil: Ditemukan perbedaan yang signifikan dari nilai rasio neutrofil-limfosit pada pemasangan kateter hemodialisis tunnelled (selisih rerata:0,51; IK95%: -0,89 – (-0,13); nilai p: 0,01) dan non-tunnelled (selisih rerata: 0,04; IK95%: -0,08 – (-0,001); nilai p: 0,043). Tidak terdapat perbedaan yang bermakna dari rasio monosit-limfosit setelah dan sebelum pemasangan kateter hemodialisa tunnelled (selisih rerata: 0,04; IK95%: -0,003 – 0,81 ; nilai p: 0,07) maupun non- tunnelled (selisih median: 0,06; p: 0,925). Adanya perbedaan yang bermakna secara statistik dari rerata rasio trombosit limfosit setelah dan sebelum pemasangan kateter hemodialisa tunnelled (selisih rerata: 32,24; IK95%: -54,11 – (-10,38); nilai p: 0,005), namun tidak ditemukan perbedaan yang bermakna pada pemasangan kateter hemodialisa non-tunnelled (selisih rerata: 26,24; IK95%: -61,47 – 9,0; nilai p: 0,14).

Simpulan: Terdapat perbedaan respon inflamasi setelah dan sebelum pemasangan kateter hemodialsis tunnelled dan non-tunnelled, khususnya pada nilai rasio neutrofil-limfosit.

Background: Maintaining the homeostasis of body fat levels is an important thing. ABCA1 is an important protein in cholesterol efflux function, which can maintain lipid profile homeostasis. Purple sweet potato (potato ipomoea batatas) is a Convolvulaceae plant with various biological functions, one of which is anthocyanin content known to prevent hyperlipidemia through ABCA1 synthesis.   This study aims to examine the effect of purple sweet potato tuber extract on increasing levels of ABCA1.

Methods: Post-test-only study design with a control group using 50 male Wistar rats divided into 5 groups (n = 10). The negative treatment group (P0) was given standard feed, while the positive group (P4), treatment 1 (P1), treatment 2 (P2) and treatment 3 (P3) were given a hyperlipidemic diet for 8 weeks. The treatment group was then given purple sweet potato tuber extract with 3 doses, including 200mg/kg (P1), 400mg/kg (P2), and 800mg/kg (P3) for 2 weeks, and the food was returned to standard food.

Results: There was a significant increase in ABCA1 levels in P2 and P3 compared to negative controls (P <0.05), but the increase in ABCA1 in P3 was not different from positive controls.

Latar Belakang : Menjaga homeostasis kadar lemak tubuh merupakan hal yang penting. ABCA1 merupakan protein yang penting dalam fungsi efluks kolestrol yang dapat menjaga homeostasis profil lipid. Ubi ungu (Ipomoea batatas) merupakan tanaman Convolvulaceae yang memiliki berbagai fungsi biologis, salah satunya kandungan Antosianin yang diketahui dapat mencegah hiperlipidemia melalui sintesis ABCA1. Penelitian ini bertujuan untuk menguji efek ekstrak umbi ubi jalar ungu terhadap peningkatan kadar ABCA1

Metode : Desain penelitian post test only dengan kontrol grup menggunakan 50 ekor tikus wistar jantan yang dibagi menjadi 5 kelompok (n=10). Kelompok perlakuan negatif (P0) diberikan pakan standar sedangkan kelompok positif (P4), perlakuan 1(P1), perlakuan 2(P2) dan perlakuan 3(P3) diberikan diet hiperlipidemia selama 8 minggu. Kelompok perlakuan kemudian diberikan ekstrak umbi ubi jalar ungu dengan 3 dosis, antara lain 200mg/kg(P1), 400mg/kg(P2), 800mg/kg(P3) selama 2 minggu dan makanannya dikembalikan ke makanan standar.

Hasil : Terdapat peningkatan kadar ABCA1 yang signifikan pada P2 dan P3 dibandingkan dengan kontrol negatif (P<0,05) tetapi peningkatan ABCA1 pada P3 tidak berbeda dengan kontrol positif.

Background: Neutrophil Lymphocyte Ratio (NLR), which is the sum of neutrophils divided by lymphocytes, has an important role in determining the inflammatory state in the patient. RNL is one of the markers of inflammation that is simple, rapid, and can be performed on routine blood tests.

Methods: This research is a retrospective descriptive study that examined NLR levels in patients confirmed with the Omicron variant of COVID-19 infection at the Wisma Atlet COVID-19 Hospital, Kemayoran, Jakarta. Data were analyzed using SPSS version 20.0 for Windows.

Results: From 331 samples, 187 samples were found to be female and 144 samples were male. A total of 300 samples had no increase in NLR (NLR <3.13), while the other 31 samples had an increase in NLR (NLR >3.13). Cytokine storm associated with immune dysregulation occurs less in women than in men. Almost all patients with confirmed Omicron variant COVID-19 at the Wisma Atlet Kemayoran Hospital did not experience an increase in NLR.

Conclusion: The cytokine storm associated with immune dysregulation occurs less frequently in women than in men. Almost all patients confirmed with the Omicron variant of COVID-19 at Wisma Atlet Hospital Kemayoran did not experience an increase in NLR.

Latar Belakang: Rasio Limfosit Neutrofil (RNL), yang merupakan jumlah neutrofil dibagi dengan limfosit, memiliki peran penting dalam menentukan keadaan inflamasi pada pasien. RNL merupakan salah satu penanda inflamasi yang sederhana, cepat, dan dapat dilakukan pada pemeriksaan darah rutin.

Metode: Penelitian ini merupakan studi deskriptif retrospektif yang meneliti kadar RNL pada pasien terkonfirmasi infeksi COVID-19 varian Omicron di Rumah Sakit COVID-19 Wisma Atlet, Kemayoran, Jakarta. Data dianalisis dengan SPSS versi 20.0 untuk Windows.

Hasil: Dari 331 sampel, ditemukan 187 sampel berjenis kelamin perempuan dan 144 sampel berjenis kelamin laki-laki. Sebanyak 300 sampel tidak mengalami peningkatan NLR (NLR <3,13), sedangkan 31 sampel lainnya mengalami peningkatan NLR (NLR >3,13). Badai sitokin yang terkait dengan disregulasi imun terjadi lebih sedikit pada wanita dibandingkan pada pria. Hampir seluruh pasien terkonfirmasi varian Omicron COVID-19 di RS Wisma Atlet Kemayoran tidak mengalami peningkatan NLR.

Simpulan: Badai sitokin terkait dengan disregulasi imun, terjadi lebih sedikit pada wanita dibandingkan dengan laki-laki.hampir seluruh pasien terkonfirmasi COVID-19 varian Omicron di RSDC Wisma Atlet Kemayoran tidak mengalami peningkatan RNL.

Introduction: Bladder carcinoma is a common malignancy in women and is the fourth most common malignancy in men. LMR (Lymphocyte monocyte ratio) is an inexpensive and practical inflammatory biomarker that has been introduced to determine prognosis in the field of urology. The aim of this study was to determine the relationship between preoperative LMR (lymphocyte monocyte ratio) and performance status in bladder cancer patients.

Methods: This study is observational with an analytic cross-sectional study approach. This research was conducted at Sanglah Hospital in Denpasar to collect secondary data in the form of medical records from 2018 to 2022. This study used primary and secondary data derived from questionnaires and medical records.

Results: Based on this study, the mean age of the research sample was 60.56 ± 7.606 years. The LMR cut point value for Performance Status is 2.474. In the ROC curve analysis, the area under the curve was found to be 0.917, with a sensitivity value of 86.36% and a specificity of 95.45%. The results of the bivariate analysis showed that based on the results of the analysis it was found that LMR had a significant relationship to performance status (p <0.001) with a PR value of 133.00 (95% CI = 20.510-86.473). The results of the logistic regression test show that LMR (categorized based on the cut point of 2.474) is significantly related to Performance Status.

Conclusion: Based on the research results show that the LMR value is related to Performance Status as measured using the Karnofsky Score.

Pendahuluan: Karsinoma buli adalah keganasan yang umum pada wanita dan merupakan keganasan keempat yang paling umum pada pria. Banyak pemeriksaan biomarker terkait keganasan yang berdasarkan pada gambaran patologis dan marker molecular, namun mahal dan tidak selalu rutin dilakukan sehari-hari. LMR (Lymphocyte monocyte ratio) merupakan salah satu biomarker inflamasi yang murah dan praktis ini mulai diperkenalkan untuk menentukan prognosis di bidang urologi. Tujuan penelitian adalah untuk mengetahui hubungan LMR (lymphocyte monocyte ratio) pre operatif dengan performance status pada pasien karsinoma buli.

Metode: Penelitian ini adalah suatu penelitian observasional dengan pendekatan studi potong lintang analitik. Penelitian ini dilaksanakan di RSUP Sanglah Denpasar untuk melakukan pengambilan data sekunder berupa rekam medis, mulai dari tahun 2018 sampai dengan tahun 2022. Penelitian ini menggunakan data primer dan sekunder  berasal dari kuesioner dan rekam medis.

Hasil: Berdasarkan penelitian ini, rerata usia sampel penelitian adalah sebesar 60,56 ± 7,606 tahun. Nilai titik potong LMR terhadap Performance Status adalah sebesar 2,474. Pada analisis kurva ROC ditemukan nilai area di bawah kurva sebesar 0,917 dengan nilai sensitivitas sebesar 86,36% dan spesifisitas sebesar 95,45%. Hasil analisis bivariat menunjukkan bahwa Berdasarkan hasil analisis ditemukan bahwa LMR memiliki hubungan yang signifikan terhadap performance status (p<0,001) dengan nilai PR sebesar 133,00 (IK 95% = 20,510-86,473). Hasil uji regresi logistik menunjukkan bahwa LMR (dikategorikan berdasarkan titik potong 2,474) berhubungan secara signifikan dengan Performance Status.

Simpulan: Berdasarkan hasil penelitian menunjukkan bahwa nilai LMR berhubungan dengan Performance Status yang diukur dengan menggunakan Karnofsky Score.

Background: Newborn babies experience jaundice in about 60% to 80% of cases. Differentiating between intrahepatic and extrahepatic cholestasis may require invasive examinations such as cholangiography and liver biopsy. Liver function tests are used to diagnose early cholestasis, distinguish between intrahepatic and extrahepatic cholestasis, monitor treatment response, and predict prognosis.

Objective: To understand the relationship between liver function tests and intrahepatic and extrahepatic cholestasis.

Methods: An observational analytical study was conducted cross-sectionally, using medical records of cholestasis patients treated at RSUP Prof. Dr. I.G.N.G Ngoerah, Denpasar, from January 2015 to May 2023. The study population comprised infants aged 0-3 months with cholestasis who met the inclusion and exclusion criteria. The diagnosis of intrahepatic and extrahepatic cholestasis was confirmed by liver biopsy.

Results: Among 52 cholestasis patients, 34 had extrahepatic cholestasis (biliary atresia), and 18 had intrahepatic cholestasis. The median AST in the intrahepatic group was 231.0 [31.7 – 790.7], p-value=0.744. The median ALT in the intrahepatic group was 161.6 [10.1 – 408.1], p-value=0.46. The mean ALP in the extrahepatic group was 458.32±152.56, p-value=0.3. The median GGT in the extrahepatic group was 654 [67 – 3568], p-value=0.002. The median total bilirubin in the intrahepatic group was 9.2 [0.19 – 29.35], p-value=0.281. The median conjugated bilirubin in the extrahepatic group was 7.78 [2.07 – 22.9], p-value=0.331.

Conclusion: Laboratory results for liver function tests in patients with intrahepatic and extrahepatic cholestasis did not differ significantly except for GGT, which was higher in patients with extrahepatic cholestasis. GGT showed the best diagnostic ability compared to other liver function test results.

Latar belakang: Bayi baru lahir mengalami penyakit kuning sekitar 60% sampai 80%. Kesulitan dalam membedakan kolestasis intra dan ekstrahepatal memerlukan pemeriksaan invasif seperti kolangiografi dan biopsi hati. Tes fungsi hati digunakan untuk menegakkan diagnosis dini kolestasis, untuk membedakan kolestasis intra dari ekstrahepatik, untuk menindaklanjuti respon pada pengobatan, dan untuk memprediksi prognosis.

Tujuan: Mengetahui hubungan antara tes fungsi hati dengan kolestasis intrahepatik dan ekstrahepatik.

Metode : Penelitian analitik observasional dilakukan secara potong lintang, menggunakan rekam medis pasien kolestasis yang dirawat di RSUP Prof. Dr. I.G.N.G Ngoerah, Denpasar sejak Januari 2015 hingga Mei 2023. Populasi penelitian ini adalah bayi 0-3 bulan dengan kolestasis yang memenuhi kriteria inklusi dan eksklusi. Diagnosis kolestasis intrahepatik dan ekstrahepatik dikonfirmasi oleh biopsi hati.

Hasil: Pada 52 anak kolestasis, 34 anak dengan kolestasis ekstrahepatik (atresia bilier) dan 18 anak dengan kolestasis intrahepatik. Median AST pada kelompok intrahepatal 231,0 [31,7 – 790,7], nilai p=0,744. Median ALT pada intrahepatal 161,6 [10,1 – 408,1], nilai p=0,46. Rerata ALP kelompok ekstrahepatal 458,32±152,56, nilai p=0,3. Median GGT kelompok ekstrahepatal 654 [67 – 3568], nilai p=0,002. Median total bilirubin kelompok intrahepatal 9,2 [0,19 – 29,35], nilai p=0,281. Median bilirubin terkonjugasi kelompok ekstrahepatal 7,78 [2,07 – 22,9], nilai p=0,331.

Simpulan : Hasil laboratorium untuk uji fungsi hati pasien dengan kolestasis intrahepatik dan ekstrahepatik tidak berbeda secara signifikan kecuali untuk GGT yang lebih tinggi pada pasien kolestasis ekstrahepatik. GGT memiliki kemampuan diagnostik terbaik dibandingkan dengan hasil tes fungsi hati lainnya.

Introduction: Skin aging is a biological process that cannot be avoided. Repeated UVB exposure increases collagen degradation by increasing MMP-9 levels. Little is known about TIMP-1's potential role in skin protection or recovery from skin damage caused by photoaging. Sugar apple leaf extract increases cell proliferation, levels and collagen deposition. This study aims to determine the topical application of sugar apple leaf cream extract (Annona squamosa L.) to increase TIMP-1 levels and decrease MMP-9 levels in Wistar rats (Rattus norvegicus) exposed to UVB light.

Methods: Experimental study with a post-test-only design with a control group design using 35 male Wistar rats. There were five groups: negative control, positive control, and treatment (5%, 10%, and 20% sugar apple leaf extract cream). Skin biopsies were taken to measure TIMP-1 and MMP-9 levels using the ELISA method. Data analysis was performed using the SPSS 25.0 application.

Results: The phytochemical test showed total flavonoid levels of 3583.77 mg QE/100 mL, phenol 5244.98 mg GAE/100 mL, IC50 value 226.53 ppm, and alkaloids. The highest mean TIMP-1 level in the treatment group was 38.95 ± 3.31 ng/mL, and the lowest mean MMP-9 level was 2.94 ± 1.66 ng/mL (20% concentration). One Way ANOVA showed that there were significant differences in TIMP-1 and MMP-9 levels between the test groups with a p<0.001. Post hoc LSD analysis showed significantly higher TIMP-1 and lower MMP-9 levels (p<0.05) than the control.

Conclusion: Administration of sugar apple leaf cream extract increased TIMP-1 levels and significantly decreased MMP-9 levels in Wistar rats exposed to UVB light.

Pendahuluan: Penuaan kulit merupakan proses biologis yang tidak dapat dihindari. Paparan UVB berulang meningkatkan degradasi kolagen dengan meningkatkan kadar MMP-9. Potensi keterlibatan TIMP-1 dalam perlindungan kulit atau pemulihan dari adanya kerusakan kulit akibat photoaging masih belum banyak diketahui. Ekstrak daun srikaya diketahui dapat meningkatkan proliferasi sel, kadar dan deposisi kolagen. Tujuan penelitian ini adalah untuk mengetahui aplikasi topikal ekstrak krim daun srikaya (Annona squamosa L.) dalam meningkatkan kadar TIMP-1 dan menurunkan kadar MMP-9 pada tikus wistar (Rattus norvegicus) yang terpapar sinar UVB.

Metode: Penelitian eksperimental dengan rancangan post-test-only with control group design ini menggunakan 35 tikus wistar jantan. Terdapat lima kelompok, yaitu kontrol negatif, kontrol positif, dan perlakuan (krim ekstrak daun srikaya 5%, 10%, dan 20%). Biopsi kulit diambil untuk pengukuran kadar TIMP-1 dan MMP-9 dengan metode ELISA. Analisis data dilakukan dengan menggunakan aplikasi SPSS 25.0.

Hasil: Uji fitokimia menunjukkan kadar total flavonoid sebanyak 3583,77 mg QE/100 mL; fenol 5244,98 mg GAE/100 mL, nilai IC50 226,53 ppm, dan alkaloid positif. Rerata kadar TIMP-1 tertinggi pada kelompok perlakuan adalah 38,95 ± 3,31 ng/mL dan rerata kadar MMP-9 terendah yaitu 2,94 ± 1,66 ng/mL (konsentrasi 20%). Analisis One Way ANOVA menunjukkan terdapat perbedaan kadar TIMP-1 dan MMP-9 yang signifikan antara kelompok uji dengan nilai p<0,001. Analisis post hoc LSD menunjukkan kadar TIMP-1 lebih tinggi dan kadar MMP-9 lebih rendah secara signifikan (p<0,05) dibandingkan kontrol.

Simpulan: Pemberian ekstrak krim daun srikaya dapat meningkatkan kadar TIMP-1 dan menurunkan kadar MMP-9 secara signifikan pada tikus wistar yang terpapar sinar UVB.

Introduction: Type 2 diabetes mellitus in the elderly causes various complications, including sarcopenia, characterized by a decrease in skeletal muscle mass and function. Several previous studies have shown that type 2 diabetes, or high plasma glucose levels cause a reduction in hand grip strength in the elderly. Therefore, this study aims to evaluate the relationship between hand grip strength and blood sugar levels in the elderly in Melinggih Village, Payangan District, Gianyar.

Methods: The study used an analytical method with a cross-sectional approach to 88 elderly people in Melinggih Village, Payangan District, Gianyar. The variables assessed included hand grip strength as the dependent variable and blood sugar levels as the independent variable. Gender, age, education level, body mass index, blood pressure, comorbidities, smoking, and medical history were considered confounding variables. The Asian Working Group guides the criteria for determining hand grip strength for Sarcopenia (AWGS) 2019. Data analysis used the chi-square test and multivariate logistic regression.

Results: Bivariate analysis showed a significant relationship between patients with high plasma glucose levels and weak hand grip strength (p=0.037; OR: 5.938; 95%CI: 1.07-32.75). However, this study found no significant relationship between plasma glucose levels with age, gender, BMI, history of comorbid diseases, smoking, and long-term drug use (p>0.05).

Conclusion: High plasma glucose levels are associated with weak hand grip strength.

Pendahuluan: Diabetes Melitus (DM) tipe 2 pada lansia menyebabkan berbagai macam komplikasi, salah satunya adalah sarkopenia yang ditandai dengan penurunan massa dan fungsi otot rangka tubuh. Beberapa penelitian sebelumnya menunjukkan bahwa DM tipe 2 atau kadar glukosa plasma yang tinggi menyebabkan penurunan kekuatan genggaman tangan pada lansia. Penelitian ini bertujuan untuk mengetahui hubungan antara kekuatan genggaman tangan dengan kadar gula darah sewaktu pada lansia di Desa Melinggih, Kecamatan Payangan Gianyar.

Metode: Penelitian menggunakan metode analitik dengan pendekatan potong lintang terhadap 88 lansia di Desa Melinggih, Kecamatan Payangan, Gianyar. Variabel yang dinilai meliputi kekuatan genggaman tangan sebagai variabel terikat dan kadar gula darah sewaktu sebagai variabel bebas. Jenis kelamin, usia, tingkat pendidikan, indeks massa tubuh, tekanan darah, penyakit penyerta, merokok, dan riwayat pengobatan dianggap sebagai variabel pengganggu. Kriteria untuk menentukan kekuatan genggaman tangan berpedoman pada Asian Working Group for Sarcopenia (AWGS) 2019. Analisis data menggunakan uji chi-square dan regresi logistik multivariat.

Hasil: Analisis bivariat menunjukkan adanya hubungan yang signifikan antara pasien dengan kadar gula darah sewaktu yang tinggi dengan kekuatan genggaman tangan yang lemah (p=0,037; OR: 5,938; 95%CI: 1,07-32,75). Namun dalam penelitian ini tidak ditemukan hubungan yang signifikan antara kadar gula darah sewaktu dengan usia, jenis kelamin, IMT, riwayat penyakit komorbid, merokok, dan penggunaan obat dalam jangka waktu lama (p>0,05).

Simpulan: Kadar gula darah sewaktu yang tinggi berhubungan dengan kekuatan genggaman tangan yang lemah.

Background: Leprosy as one of the neglected tropical diseases which can attack various parts of body causing disability. Indonesia ranks 3^rd in the highest leprosy cases in the world, with six provinces yet to achieve leprosy elimination. Bali Province has achieved leprosy elimination but has yet to achieve free leprosy. Klungkung Regency is included in the top three regencies in Bali, with the highest prevalence of leprosy. In the Pandemic, COVID-19 has impacted efforts to control leprosy. This study aims to determine the prevalence and characteristics of leprosy patients in Klungkung Regency during the COVID-19 pandemic

Methods: A cross-sectional study was conducted using secondary data from Klungkung District Health Office for 2019-2021. The data will be obtained from July-September 2022. The research sample of 22 leprosy patients was obtained by purposive sampling technique.

Results: Leprosy prevalence of 0.95/10,000 population in 2019 (pre-pandemic), 0.1/10,000 population in 2020 (first-year pandemic), and 0.28/10,000 population in 2021 (second-year pandemic). The distribution of leprosy patients is dominant aged 15-64 years (86.4%), male (59.1%), last education SD/equivalent (68.2%), farmer occupation (40.9%), from Nusa Penida sub-district (54.5%), registered in primary health facilities (100%), multibacillary leprosy type (100%), and COVID-19 status is not infected (100%).

Conclusion: The prevalence of leprosy fluctuated in the Klungkung Regency during the COVID-19 pandemic. Has achieved the leprosy elimination target but is categorized as areas with a high burden of leprosy. Leprosy patient in this regency has variant characteristics.

Latar belakang: Kusta sebagai salah satu penyakit tropis terabaikan yang menyerang berbagai bagian tubuh serta dapat menimbulkan kecacatan. Indonesia menempati peringkat ketiga kasus tertinggi di dunia, dengan 6 provinsi belum mencapai eliminasi kusta. Provinsi Bali telah mencapai eleminasi kusta namun belum bebas kusta. Kabupaten Klungkung termasuk dalam 3 besar kabupaten/kota di Bali dengan prevalensi tertinggi. Pandemi COVID-19 membawa dampak pada upaya penanggulangan kusta. Penelitian ini bertujuan untuk mengetahui prevalensi dan karakteristik penderita kusta di Kabupaten Klungkung kurun pandemi COVID-19.

Metode: Penelitian ini menggunakan rancangan cross-sectional dari data sekunder Dinas Kesehatan Kabupaten Klungkung periode tahun 2019-2021. Penarikan data dilakukan selama bulan Juli-September 2022. Sampel penelitian sejumlah 22 penderita kusta didapat dengan teknik purposive sampling.

Hasil: Prevalensi kusta 0,95/10.000 penduduk tahun 2019 (pra pandemi), 0,1/10.000 penduduk tahun 2020 (pandemi tahun pertama), dan 0,28/10.000 penduduk tahun 2021 (pandemi tahun kedua). Distribusi penderita dominan berusia 15-64 tahun (86,4%), laki-laki (59,1%), pendidikan terakhir SD/sederajat (68,2%), pekerjaan petani (40,9%), asal daerah Kecamatan Nusa Penida (54,5%), terdaftar di faskes primer (100%), tipe kusta Multibasiler (100%), dan status COVID-19 tidak terinfeksi (100%).

Simpulan: Prevalensi kusta di Kabupaten Klungkung kurun pandemi COVID-19 berfluktuasi. Telah mencapai target eleminasi kusta namun termasuk daerah dengan beban kusta tinggi (high burden). Karakteristik penderita kusta pada daerah ini beragam. 

Introduction: Lactate was an examination done in patients with shock as a predictor of mortality. The delta shock index (DSI) is one of the parameters that are easy to do but very limited studies related to the benefits of DSI have been found. This study aimed at determining the correlation of DSI and lactate clearance levels in pediatric shock patients treated at the Pediatric Intensive Care Unit (PICU) of Prof Dr. I.G.N.G Ngoerah  Hospital.

Method: This was a prospective cohort study of children diagnosed with shock in a pediatric emergency ward or PICU Prof Dr. I.G.N.G Ngoerah  Hospital. A Spearman correlation test was done since the data distribution was abnormal. Multivariate analysis with multiple regression tests was carried out to assess the pure effect of lactate clearance with DSI. The level of significance was determined based on p <0.05. The general linear model analysis is done on variables that are repeated measurements.

Result: There were 39 subjects obtained in this study, with 34 subjects surviving and 5 subjects not surviving. The median lactate clearance was 28.5 (-95 - 77.7), with a median DSI of 0.45 (0.04-1.3). There were significant differences in the decrease of shock index over time (p = 0.034). The correlation test results showed a weak positive between lactate clearance with DSI (r = +0.351) and p = 0.028. Multivariate analysis test results obtained a value of â 0.002 with p = 0.071.

Conclusion: There was a weak positive correlation between lactate clearance and DSI. There were significant differences in the decrease of shock index over time between survivors and non-survivors.

Introduction. Breast cancer is a disease with complex and heterogeneous condition which can be assessed from its morphology, molecular subtypes, and patient response to treatment. Treatment is individualized based on predictive and prognostic factors. Based on this, molecular examination is very important and the Muhammad Yunus Bengkulu Hospital opened cancer patient services and continues to improve its services, especially for breast cancer. It has been recorded since mid-2021 that were 77 patients who underwent  immunohistochemical examinations independently. The purpose of this study was to determine the distribution of various molecular subtypes of breast cancer at M Yunus Hospital Bengkulu and their relationship with histopathological grading in breast cancer patients.

Method. A cross-sectional study was conducted on breast cancer patients who went  to the Surgical Oncology Polyclinic at M Yunus Bengkulu Hospital. In this study, we used medical record data in the form of laboratory results as research subjects, which were then analyzed  using SPSS 25 for windows. The relationship between variables is stated to  significant if the p-value <0.05.

Results. From 77 breast cancer patients whose molecular subtypes were examined, the average age was 50 (standard deviation of 12) years. Most of the histopathological grades were grade 3 (41.60%), then grade 2 (23.40%), at least grade 1 (5.20%), and could not be determined quite a lot, namely 29.9%. ER status was mostly positive (67.50%), then PR status was more positive (53.20%), HER2 was mostly negative (61.00%), and triple-negative was 13.00%. For Ki67, mostly >20% (75.30%). According to the findings of statistical analyses using the Chi-Square test, p>0.05, indicates that there is no correlation between the histopathological grade and the molecular subtype of breast cancer patients (p=0.199).

Conclusion. Histopathological grading and molecular subtype do not significantly correlate.

Pendahuluan. Kanker pada payudara merupakan suatu penyakit dengan kondisi yang komplek dan heterogen yang dapat dinilai dari bentuk morfologi, subtipe molekuler nya, respon pasien terhadap pengobatan karena pengobatan bersifat individual yang berdasarkan faktor prediktif dan prognostik. Berdasarkan hal tersebut maka pemeriksaan molekuler sangatlah penting, dan di Rumah Sakit Muhammad Yunus Bengkulu membuka layanan pasien kanker dan terus  meningkatkan pelayanannya terutama pada kanker payudara dan sudah tercatat sejak pertengahan 2021 terdapat 77 pasien yang dilakukan pemeriksaan immunohistokimia secara mandiri. Tujuan pada penelitian ini adalah untuk mengetahui distribusi pada berbagai subtipe molekuler kanker payudara di RSUD M Yunus Bengkulu dan  hubungan nya dengan grading histopatologinya pada penderita kanker payudara.

Metode. Studi potong lintang dilakukan pada penderita kanker payudara yang berobat rutin ke Poliklinik Bedah Onkologi di RSUD M Yunus Bengkulu. Pada penelitian ini menggunakan data rekam medik yang berupa hasil laboratorium sebagai subjek penelitiannya yang selanjutnya di analisis menggunakan SPSS 25 for windows. Hubungan antar variabel dinyatakan bermakna apabila nilai p<0,05.

Hasil. Dari total 77 subjek pasien kanker payudara yang di periksa subtipe molekulernya didapatkan rerata usia 50 (simpang baku 12) tahun. Didapatkan grade histopatologis paling banyak grade 3 (41,60%), kemudian grade 2 (23,40%), yang paling sedikit grade 1 (5,20%), dan tidak dapat ditentukan cukup banyak yaitu 29,90%. Status ER sebagian besar positif (67,50%), kemudian status PR lebih banyak positif (53,20%), sedangkan HER2 sebagian besar negatif (61,00%), Triple negatif ada sebesar 13,00%. Ki67 sebagian besar >20% (75,30%). Dari hasil uji statistik dengan Uji Chi-Square p>0.05 yang artinya subtipe molekuler pada pasien kanker payudara tidak memiliki hubungan dengan grading histopatologinya (p=0.199).

Simpulan. Tidak ada hubungan bermakna antara subtipe molekuler dengan grading histopatologis nya.

Background: The characteristics of febrile seizures are generally reported by parents subjectively. The neutrophil-to-lymphocyte ratio (NLR) is proposed as an objective parameter that can distinguish simple and complex febrile seizures. This study aims to assess the difference in NLR in children with simple and complex febrile seizures.

Methods: A cross-sectional study was conducted using secondary data from medical records, at the Sanjiwani Regional General Hospital, Gianyar City, on pediatric patients aged six months to five years diagnosed with febrile seizures and treated in the period January-October 2022. The dependent variable in this study was the classification of febrile seizures, so the sample was divided into simple and complex febrile seizure groups. The NLR value was obtained by calculating the ratio of neutrophil and lymphocyte counts from the complete blood count results. The Mann-Whitney test assessed the difference in NLR value in the two groups.

Results: There were 52 children included as research subjects. The majority of the samples were ≥1 year old (94.2%), female (53.8%), and diagnosed with simple febrile seizure (71.2%). The samples' median (minimum-maximum) NLR was 4.54 (0.4-16.4). This study found no significant difference in NLR values between the simple and complex febrile seizure groups (p = 0.976).

Conclusion: There was no significant difference in NLR values between the groups of simple and complex febrile seizures. Further research is needed to determine NLR's cut-off point and correlation with simple and complex febrile seizures.

Latar belakang: Karakteristik kejang demam umumnya dilaporkan oleh orang tua secara subyektif. Rasio neutrofil dan limfosit (NLR) diusulkan sebagai parameter objektif yang dapat membedakan kejang demam sederhana (KDS) dan kompleks (KDK). Studi ini bertujuan untuk menilai perbedaan NLR pada anak dengan KDS dan KDK.

Metode: Penelitian cross-sectional dilakukan menggunakan data sekunder dari rekam medik di Rumah Sakit Umum Daerah (RSUD) Sanjiwani Gianyar, pada pasien anak berusia enam bulan hingga lima tahun didiagnosis dengan kejang demam dan dirawat pada periode Januari-Oktober 2022. Variabel terikat pada penelitian ini adalah klasifikasi kejang demam, sehingga sampel dibagi menjadi kelompok KDS dan KDK. Nilai NLR diperoleh dengan menghitung rasio jumlah neutrofil dan limfosit dari hasil pemeriksaan darah lengkap. Uji Mann-Whitney digunakan untuk menilai perbedaan nilai NLR pada dua kelompok.

Hasil: Terdapat 52 anak yang diikutkan sebagai subyek penelitian. Mayoritas sampel berusia ≥1 tahun (94,2%), perempuan (53,8%), dan di diagnosis dengan KDS (71,2%). Median (minimum-maksimum) NLR sampel adalah 4,54 (0,4-16,4). Tidak terdapat perbedaan nilai NLR bermakna ditemukan antara kelompok KDS dan KDK pada penelitian ini (p = 0,976).

Kesimpulan: Tidak terdapat perbedaan nilai NLR yang bermakna antara kelompok KDS dan KDK. Penelitian selanjutnya diperlukan untuk menentukan cut off point dan kuat korelasi NLR dengan KDS dan KDK.